Individual
DR. MYSORE R NAGARAJA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
811 E 11TH ST STE 208, UPLAND, CA 91786-4872
(909) 982-2279
(909) 946-3070
Mailing address
17075 DEVONSHIRE ST STE 200, NORTHRIDGE, CA 91325-5407
(818) 363-3105
(818) 363-6178
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A25685
CA
207RG0100X
Gastroenterology Physician
Primary
A25685
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A256850
—
CA
01
—
W5281
MEDICARE ID
CA
Enumeration date
03/16/2006
Last updated
09/18/2023
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