Provider Demographics
NPI:1740018340
Name:RAGHANI, POOJA
Entity type:Individual
Prefix:
First Name:POOJA
Middle Name:
Last Name:RAGHANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13260 HEACOCK ST APT A7
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3145
Mailing Address - Country:US
Mailing Address - Phone:480-310-6428
Mailing Address - Fax:
Practice Address - Street 1:13260 HEACOCK ST APT A7
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3145
Practice Address - Country:US
Practice Address - Phone:480-310-6428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61372185103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical