Provider Demographics
NPI:1629351333
Name:WADHAVA, RAJESH HANSRAJ
Entity Type:Individual
Prefix:MR
First Name:RAJESH
Middle Name:HANSRAJ
Last Name:WADHAVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 ORO DAM BLVD E
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-5116
Mailing Address - Country:US
Mailing Address - Phone:530-534-1283
Mailing Address - Fax:530-534-1830
Practice Address - Street 1:2703 ORO DAM BLVD E
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-5116
Practice Address - Country:US
Practice Address - Phone:530-534-1283
Practice Address - Fax:530-534-1830
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 63763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist