Provider Demographics
NPI:1366930661
Name:RAKHRA, PAVANDEEP (DO)
Entity type:Individual
Prefix:
First Name:PAVANDEEP
Middle Name:
Last Name:RAKHRA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W LA VETA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4203
Mailing Address - Country:US
Mailing Address - Phone:714-509-7984
Mailing Address - Fax:855-246-2329
Practice Address - Street 1:1201 W LA VETA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4203
Practice Address - Country:US
Practice Address - Phone:714-509-7984
Practice Address - Fax:855-246-2329
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A241232080P0205X
390200000X
TXBP10078259390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology