Provider Demographics
NPI:1942394275
Name:RAJ, JACINTHA L (MD)
Entity Type:Individual
Prefix:
First Name:JACINTHA
Middle Name:L
Last Name:RAJ
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 1:1020 S 40TH AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3800
Mailing Address - Country:US
Mailing Address - Phone:509-966-3969
Mailing Address - Fax:509-966-3979
Practice Address - Street 1:1020 S 40TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3800
Practice Address - Country:US
Practice Address - Phone:509-966-3969
Practice Address - Fax:509-966-3979
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044674207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8425530Medicaid
WA9392RAOtherREGENCE
WA0237844OtherLABOR AND INDUSTRIES
WA9392RAOtherREGENCE
I37072Medicare UPIN