Organization
DEEPAK THIAGARAJAN, A PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEEPAK THIAGARAJAN MD (OWNER)
(909) 921-3920
Entity
Organization
Contact information
Practice address
7974 HAVEN AVE STE 210, RANCHO CUCAMONGA, CA 91730-3052
(909) 881-5994
Mailing address
5036 RODEO RD, ALTA LOMA, CA 91737-2408
(909) 921-3920
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A113059
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7516240
—
CA
Enumeration date
06/05/2013
Last updated
04/04/2024
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