Provider Demographics
NPI:1861861262
Name:RAJU, BETTINA RACHEL
Entity type:Individual
Prefix:MRS
First Name:BETTINA
Middle Name:RACHEL
Last Name:RAJU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 W 18TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1289
Mailing Address - Country:US
Mailing Address - Phone:281-668-8802
Mailing Address - Fax:
Practice Address - Street 1:18842 S MEMORIAL DR STE 206
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4229
Practice Address - Country:US
Practice Address - Phone:713-426-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3776486-05Medicaid