Provider Demographics
NPI:1669702478
Name:RAJA, TASNEEM MUSTAFA (LAC, MSC)
Entity type:Individual
Prefix:
First Name:TASNEEM
Middle Name:MUSTAFA
Last Name:RAJA
Suffix:
Gender:F
Credentials:LAC, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 SNAKE RIVER ROAD
Mailing Address - Street 2:SUITE E
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-4631
Mailing Address - Country:US
Mailing Address - Phone:281-435-2411
Mailing Address - Fax:
Practice Address - Street 1:1822 SNAKE RIVER ROAD
Practice Address - Street 2:SUITE E
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-7756
Practice Address - Country:US
Practice Address - Phone:281-435-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00576171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist