| Deepak Thiagarajan, A Professional Medical Corporation | |
| 
					7974 Haven Ave Ste 210 Rancho Cucamonga CA 91730-3052  | |
| (909) 881-5994 | |
| Not Available | 
| Full Name | Deepak Thiagarajan, A Professional Medical Corporation | 
|---|---|
| Speciality | Internal Medicine | 
| Location | 7974 Haven Ave Ste 210, Rancho Cucamonga, California | 
| Authorized Official Name and Position | Deepak Thiagarajan (OWNER) | 
| Authorized Official Contact | 9099213920 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Deepak Thiagarajan, A Professional Medical Corporation 5036 Rodeo Rd Alta Loma CA 91737-2408 Ph: (909) 921-3920  | Deepak Thiagarajan, A Professional Medical Corporation 7974 Haven Ave Ste 210 Rancho Cucamonga CA 91730-3052 Ph: (909) 881-5994  | 
| NPI Number | 1043658644 | 
|---|---|
| Provider Enumeration Date | 06/05/2013 | 
| Last Update Date | 04/04/2024 | 
| Medicare PECOS PAC ID | 8123260270 | 
|---|---|
| Medicare Enrollment ID | O20130820000402 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1043658644 | NPI | - | NPPES | 
| 7516240 | Medicaid | CA | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207R00000X | Internal Medicine | A113059 (California) | Primary | 
| Provider Name | Deepak V Thiagarajan | 
|---|---|
| Provider Type | Practitioner - Hospitalist | 
| Provider Identifiers | NPI Number: 1205052990 PECOS PAC ID: 2961596085 Enrollment ID: I20110419000793  | 
Carlos R. Vigil, D.o. (a Professional Corporation) Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 7974 Haven Ave, Suite 210, Rancho Cucamonga, CA 91730 Phone: 909-941-0661 Fax: 909-948-5577  | |
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