Provider Demographics
NPI:1528120540
Name:SHETTIGAR, RAGHU D (MD)
Entity type:Individual
Prefix:
First Name:RAGHU
Middle Name:D
Last Name:SHETTIGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 EUCLID AVE STE 409
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2981
Mailing Address - Country:US
Mailing Address - Phone:619-267-8313
Mailing Address - Fax:619-472-2009
Practice Address - Street 1:655 EUCLID AVE STE 409
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2981
Practice Address - Country:US
Practice Address - Phone:619-267-8313
Practice Address - Fax:619-472-5008
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6633207V00000X
CAC144284207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160697204Medicaid
TX8L14625Medicare PIN
TXH90639Medicare UPIN