Nagaraja, Mysore R

Nagaraja, Mysore R is an sole proprietor health care provider with primary practice located at 811 E 11Th St Ste 208 , Upland CA 91786-4872. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Gastroenterology. Allopathic & Osteopathic Physicians / Gastroenterology is his primary health care specialty. Nagaraja, Mysore R can be contacted via phone (909) 982-2279.

Contact Information

Primary practice address
811 E 11Th St Ste 208 Upland CA 91786-4872
Phone: (909) 982-2279
Fax: (909) 946-3070
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X A25685 California
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X A25685 California

Profile Details

NPI number 1760451298
LBN Legal business name Nagaraja, Mysore R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 16th, 2006
Last updated Sep 18th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760451298 NPPES
California MEDICAID 00A256850
California Other W5281

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