Individual
DEEPAK THIAGARAJAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7974 HAVEN AVE STE 210, RANCHO CUCAMONGA, CA 91730-3052
(909) 881-5994
(909) 248-7769
Mailing address
5036 RODEO RD, ALTA LOMA, CA 91737-2408
(909) 881-5994
(909) 248-7769
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD12318
RI
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
A 113059
CA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
LP00988
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32935-4
BCBS
RI
01
—
414203
BLUECHIP
RI
01
—
AA91479
HPHC - MIRIAM
RI
05
—
DT68425
—
RI
Enumeration date
04/18/2007
Last updated
04/04/2024
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