Provider Demographics
NPI:1023766375
Name:VASUDEVAN, RAJIV SIDDHARTHA
Entity type:Individual
Prefix:
First Name:RAJIV
Middle Name:SIDDHARTHA
Last Name:VASUDEVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF CALIFORNIA SAN DIEGO SCHOOL OF MEDICINE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-1329
Mailing Address - Country:US
Mailing Address - Phone:650-714-7908
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF CALIFORNIA SAN DIEGO SCHOOL OF MEDICINE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0001
Practice Address - Country:US
Practice Address - Phone:650-714-7908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program