Provider Demographics
NPI:1902246523
Name:SIVARAJAN, RAGU (DO,)
Entity Type:Individual
Prefix:DR
First Name:RAGU
Middle Name:
Last Name:SIVARAJAN
Suffix:
Gender:M
Credentials:DO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3282
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729-3282
Mailing Address - Country:US
Mailing Address - Phone:909-330-3939
Mailing Address - Fax:909-352-5322
Practice Address - Street 1:1304 W HOLT BLVD STE A
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3640
Practice Address - Country:US
Practice Address - Phone:909-330-3939
Practice Address - Fax:909-352-5322
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A14906207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine