Healthcare Provider Details

I. General information

NPI: 1598125791
Provider Name (Legal Business Name): RAGHAV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12361 W BOLA DR STE 109
SURPRISE AZ
85378-9021
US

IV. Provider business mailing address

12361 W BOLA DR STE 109
SURPRISE AZ
85378-9021
US

V. Phone/Fax

Practice location:
  • Phone: 623-227-1000
  • Fax: 623-227-2000
Mailing address:
  • Phone: 623-227-1000
  • Fax: 623-227-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number41238
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. HARESH BOGHARA
Title or Position: OWNER
Credential: M.D.
Phone: 214-250-2140