Individual provider Active NPI

Maya Vijayaraghavan, M.D.

  • Internal Medicine Physician
  • San Diego, CA
National Provider Identifier
1790969616
Registry record updated Jul 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
246179 Issued in NY
Practice address
1809 National Avenue
6TH Floor, Ctr12
San Diego, CA 92113
Phone
(619) 906-4623
Fax
(619) 906-4564
NPI assigned
Dec 27, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 246179 NY Primary

Addresses

Primary practice location

1809 National Avenue
6TH Floor, Ctr12
San Diego, CA 92113

Mailing address

823 Gateway Center Way
Box 4
San Diego, CA 92102
Phone (619) 906-4623

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091019000230 CA Practitioner - Internal Medicine 9436296712 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
246179NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of California SFGH Medical Group CurrentSince Apr 1, 2015 Accepting new patients
University of California SFGH Medical Group Current Accepting new patients
City and County of San Francisco CurrentSince Nov 10, 2019 Accepting new patients
University of California SFGH Medical Group Internal Medicine CurrentSince Apr 1, 2015 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Dec 14, 2014 Accepting new patients
City & County of San Francisco CurrentSince Nov 10, 2019 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Dec 14, 2014 Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients
City & County of San Francisco Current Accepting new patients

Locations

823 Gateway Center Way
#4
San Diego, CA 92102

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

1809 National Ave
Fl 6
San Diego, CA 92113
Phone (619) 906-4623

1809 National Ave
San Diego, CA 92113
Phone (619) 515-2500

1250 6th Ave
Ste 100
San Diego, CA 92101
Phone (619) 515-2430

1001 Potrero Ave
San Francisco, CA 94110
Phone (415) 206-2305

1001 Potrero Ave
Rm 5H22
San Francisco, CA 94110
Phone (628) 206-4774

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311120000000",
    "number": "1790969616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "address_2": "BOX 4",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92102",
            "telephone_number": "619-906-4623",
            "fax_number": "619-906-4564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1809 NATIONAL AVENUE",
            "address_2": "6TH FLOOR, CTR12",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92113",
            "telephone_number": "619-906-4623",
            "fax_number": "619-906-4564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIJAYARAGHAVAN",
        "first_name": "MAYA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-27",
        "last_updated": "2011-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "246179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.