Provider Demographics
NPI:1497243075
Name:RAJI, CAMILLI RENEE
Entity Type:Individual
Prefix:
First Name:CAMILLI
Middle Name:RENEE
Last Name:RAJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAMILLI
Other - Middle Name:RENEE
Other - Last Name:RAJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7710 SUMMER GLEN LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-3132
Mailing Address - Country:US
Mailing Address - Phone:713-540-7745
Mailing Address - Fax:
Practice Address - Street 1:7710 SUMMER GLEN LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-3132
Practice Address - Country:US
Practice Address - Phone:713-540-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13504106OtherHEALTH CARE PROVIDER SERVICES