Provider Demographics
NPI:1780099903
Name:MAHARAJ, ANGELA POJA (OD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:POJA
Last Name:MAHARAJ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1899 W MARCH LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6402
Mailing Address - Country:US
Mailing Address - Phone:209-623-4700
Mailing Address - Fax:209-623-4716
Practice Address - Street 1:1899 W MARCH LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6402
Practice Address - Country:US
Practice Address - Phone:209-623-4700
Practice Address - Fax:209-623-4716
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist