Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A15683 | CA |
NPI | 1003293507 |
---|---|
Provider Name | Asha Patel Raj |
First Address | Chula Vista, CA 91910-2628 |
Second Address | Chula Vista, CA 91910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2015 |
Last Update Date | 27/07/2018 |