Provider Demographics
NPI:1538271002
Name:SRIJAERAJAH, THILLAIAMPALAM (MD)
Entity type:Individual
Prefix:DR
First Name:THILLAIAMPALAM
Middle Name:
Last Name:SRIJAERAJAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:T
Other - Middle Name:
Other - Last Name:SRI MD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:A PROFESSIONAL CORP
Mailing Address - Street 1:44725 10TH ST W
Mailing Address - Street 2:230
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-948-1611
Mailing Address - Fax:661-945-5291
Practice Address - Street 1:9278 N LOOP BLVD
Practice Address - Street 2:
Practice Address - City:CALIFORNIA CITY
Practice Address - State:CA
Practice Address - Zip Code:93505-2236
Practice Address - Country:US
Practice Address - Phone:760-373-4809
Practice Address - Fax:760-373-4800
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33938207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0064250Medicaid
CAGR0064251Medicaid
CAA84542Medicare UPIN
CAGR0064251Medicaid
CAW13186Medicare ID - Type Unspecified