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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1760451298 | NPPES |
| California | MEDICAID | 00A256850 | |
| California | Other | W5281 |
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