Provider Demographics
NPI:1629423066
Name:JEEVARAJAN, JESSIE VANITHA (DO)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:VANITHA
Last Name:JEEVARAJAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 SCHERTZ PKWY
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1399
Mailing Address - Country:US
Mailing Address - Phone:210-775-0909
Mailing Address - Fax:
Practice Address - Street 1:5000 SCHERTZ PKWY
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1399
Practice Address - Country:US
Practice Address - Phone:210-775-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000390200000X
TXS2603208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program