Provider Demographics
NPI:1902899552
Name:WICKRAMASEKRAN, RAJASEKRAN (MD)
Entity Type:Individual
Prefix:
First Name:RAJASEKRAN
Middle Name:
Last Name:WICKRAMASEKRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAJ
Other - Middle Name:
Other - Last Name:WICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:15243 VANOWEN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3605
Mailing Address - Country:US
Mailing Address - Phone:818-782-5041
Mailing Address - Fax:818-782-4864
Practice Address - Street 1:18350 ROSCOE BLVD
Practice Address - Street 2:SUITE 603
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4109
Practice Address - Country:US
Practice Address - Phone:818-993-8283
Practice Address - Fax:818-993-4919
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25636207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A256360Medicaid
CAWA25636EMedicare PIN
CAWA2563KMedicare ID - Type Unspecified
CA00A256360Medicaid
CAA24516Medicare UPIN
CAWA25636CMedicare PIN
CAWA25636GMedicare PIN
CAW119Medicare PIN