Provider Demographics
NPI:1699799833
Name:RAO, VIJENDRA (MD)
Entity type:Individual
Prefix:
First Name:VIJENDRA
Middle Name:
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 COTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3303
Mailing Address - Country:US
Mailing Address - Phone:310-445-2951
Mailing Address - Fax:310-479-1459
Practice Address - Street 1:1516 COTNER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3303
Practice Address - Country:US
Practice Address - Phone:310-445-2951
Practice Address - Fax:310-479-1459
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA912252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0106039Medicaid
CAGR0106035Medicaid
CAGR010603DMedicaid
CA00A912250Medicaid
CAGR0025330Medicaid
CA00A912250Medicaid
CA00A912253Medicare PIN
CAGR0025330Medicaid
CATP051AMedicare PIN
CAWA91225IMedicare PIN
CAAO799YMedicare PIN
CA00A812251Medicare PIN
CAWA91225DMedicare PIN
CAWA91225HMedicare PIN
CAGR0048950Medicare PIN
CAWA91225BMedicare PIN
CAWA91225CMedicare PIN
CA00A912252Medicare PIN
CAGR0106039Medicaid
CAGR0106035Medicaid
CAWA91225FMedicare PIN
CAWA91225AMedicare PIN