Healthcare Provider Details

I. General information

NPI: 1346071966
Provider Name (Legal Business Name): TITILAYO RAJI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3691 W GOLDMINE MOUNTAIN DR
SAN TAN VLY AZ
85144-6592
US

IV. Provider business mailing address

3691 W GOLDMINE MOUNTAIN DR
SAN TAN VALLEY AZ
85144-6592
US

V. Phone/Fax

Practice location:
  • Phone: 602-707-6582
  • Fax:
Mailing address:
  • Phone: 602-707-6582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number313398
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: