Provider Demographics
NPI:1174898621
Name:DEVRAJ, SURAJ KRISHNA (DPT)
Entity type:Individual
Prefix:DR
First Name:SURAJ
Middle Name:KRISHNA
Last Name:DEVRAJ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15531 ROMAR ST
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2611
Mailing Address - Country:US
Mailing Address - Phone:949-307-8616
Mailing Address - Fax:
Practice Address - Street 1:15531 ROMAR ST
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2611
Practice Address - Country:US
Practice Address - Phone:949-307-8616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist