Provider Demographics
NPI:1962021220
Name:SHRESTHA, RAJANI LATA (DO)
Entity Type:Individual
Prefix:
First Name:RAJANI
Middle Name:LATA
Last Name:SHRESTHA
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 1:3107 W CAMP WISDOM RD STE 170
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-2638
Mailing Address - Country:US
Mailing Address - Phone:972-942-7700
Mailing Address - Fax:972-941-7701
Practice Address - Street 1:3107 W CAMP WISDOM RD STE 170
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2638
Practice Address - Country:US
Practice Address - Phone:972-942-7700
Practice Address - Fax:972-941-7701
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU0658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine