Provider Demographics
NPI:1811573249
Name:RAJENDRA, RAVI SAJJAN
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:SAJJAN
Last Name:RAJENDRA
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 1:5249 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-1851
Mailing Address - Country:US
Mailing Address - Phone:334-450-5776
Mailing Address - Fax:
Practice Address - Street 1:1542 TULANE AVENUE
Practice Address - Street 2:BOX T6-7
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2865
Practice Address - Country:US
Practice Address - Phone:334-450-5776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program