Provider Demographics
NPI:1083257968
Name:WASIM H RAJA MD
Entity Type:Organization
Organization Name:WASIM H RAJA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:WASIM
Authorized Official - Middle Name:H
Authorized Official - Last Name:RAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-934-4002
Mailing Address - Street 1:11100 WARNER AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7500
Mailing Address - Country:US
Mailing Address - Phone:714-486-3477
Mailing Address - Fax:833-334-0495
Practice Address - Street 1:11100 WARNER AVE STE 110
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7500
Practice Address - Country:US
Practice Address - Phone:714-486-3477
Practice Address - Fax:833-334-0495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE24295OtherINTERNAL MEDICINE