Healthcare Provider Details

I. General information

NPI: 1417875972
Provider Name (Legal Business Name): LYNCIE ELIZABETH RAJU SHIAU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. LYNCIE ELIZABETH RAJU

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15928 PROMONTORY PL
LA MIRADA CA
90638-3470
US

IV. Provider business mailing address

15928 PROMONTORY PL
LA MIRADA CA
90638-3470
US

V. Phone/Fax

Practice location:
  • Phone: 714-209-3426
  • Fax:
Mailing address:
  • Phone: 714-209-3426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95030656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: