Healthcare Provider Details

I. General information

NPI: 1093548018
Provider Name (Legal Business Name): MEENA RAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 49693
LOS ANGELES CA
90049-0693
US

IV. Provider business mailing address

PO BOX 49693
LOS ANGELES CA
90049-0693
US

V. Phone/Fax

Practice location:
  • Phone: 424-544-8471
  • Fax: 732-924-3415
Mailing address:
  • Phone: 213-718-9446
  • Fax: 732-924-3415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95031758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: