Provider Demographics
NPI:1174733059
Name:AGRAWAL, RENUKA (MD)
Entity type:Individual
Prefix:DR
First Name:RENUKA
Middle Name:
Last Name:AGRAWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 COLUMBIA
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1460
Mailing Address - Country:US
Mailing Address - Phone:949-643-7460
Mailing Address - Fax:949-425-5865
Practice Address - Street 1:31 COLUMBIA
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-1460
Practice Address - Country:US
Practice Address - Phone:949-643-7460
Practice Address - Fax:949-425-5865
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102411207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology