Provider Demographics
NPI:1093712986
Name:VENKAT, RAJI (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJI
Middle Name:
Last Name:VENKAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAJI
Other - Middle Name:
Other - Last Name:VENKATASUBRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 33269
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-3269
Mailing Address - Country:US
Mailing Address - Phone:702-616-5801
Mailing Address - Fax:
Practice Address - Street 1:10001 S EASTERN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3907
Practice Address - Country:US
Practice Address - Phone:702-616-5801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV103494OtherINDIVIDUAL PIN
NV002018780Medicaid
G37458Medicare ID - Type Unspecified
NVV103494OtherINDIVIDUAL PIN