Provider Demographics
NPI:1124465745
Name:RAJAGOPAL, AMUTHA V (M D)
Entity type:Individual
Prefix:
First Name:AMUTHA
Middle Name:V
Last Name:RAJAGOPAL
Suffix:
Gender:
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6829 PARK RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3241
Mailing Address - Country:US
Mailing Address - Phone:916-396-7541
Mailing Address - Fax:
Practice Address - Street 1:995 POTRERO AVENUE
Practice Address - Street 2:WARD 86
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:628-206-2403
Practice Address - Fax:415-502-4777
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0.36.140481207RI0200X
CAA1351672083A0300X
CA390200000X
CA135167207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program