Provider Demographics
NPI:1932895349
Name:RAJU, KERAN PARKASH (FNP)
Entity Type:Individual
Prefix:
First Name:KERAN
Middle Name:PARKASH
Last Name:RAJU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 TAMPICO DR
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-7699
Mailing Address - Country:US
Mailing Address - Phone:925-642-2924
Mailing Address - Fax:
Practice Address - Street 1:2614 TAMPICO DR
Practice Address - Street 2:
Practice Address - City:BAY POINT
Practice Address - State:CA
Practice Address - Zip Code:94565-7699
Practice Address - Country:US
Practice Address - Phone:925-642-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002738363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty