Provider Demographics
NPI:1669508206
Name:RAJA, SHEELA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEELA
Middle Name:
Last Name:RAJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12291 WASHINGTON BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-2500
Mailing Address - Country:US
Mailing Address - Phone:562-945-7252
Mailing Address - Fax:562-945-0122
Practice Address - Street 1:12291 WASHINGTON BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2500
Practice Address - Country:US
Practice Address - Phone:562-945-7252
Practice Address - Fax:562-945-0122
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A773010Medicaid
CA00A773010Medicaid
WA77301AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER