Provider Demographics
NPI:1861566572
Name:RAJANI, RAJ PARSRAM (MD)
Entity type:Individual
Prefix:
First Name:RAJ
Middle Name:PARSRAM
Last Name:RAJANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAJ
Other - Middle Name:PARSRAM
Other - Last Name:RAJANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD , INC
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91788-0631
Mailing Address - Country:US
Mailing Address - Phone:714-833-6411
Mailing Address - Fax:503-285-3590
Practice Address - Street 1:1820 FULERTON AVE
Practice Address - Street 2:SUITE #210
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881
Practice Address - Country:US
Practice Address - Phone:714-833-6411
Practice Address - Fax:503-285-3590
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA425802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10968216OtherCAQH ID #
CA10968216OtherCAQH ID #
CAA85809Medicare UPIN