Healthcare Provider Details

I. General information

NPI: 1134783525
Provider Name (Legal Business Name): NIKITA R RAJAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 SUMMIT ST STE 2D
OAKLAND CA
94609-3416
US

IV. Provider business mailing address

4096 PIEDMONT AVE # 1000
OAKLAND CA
94611-5221
US

V. Phone/Fax

Practice location:
  • Phone: 510-982-1000
  • Fax: 510-210-9310
Mailing address:
  • Phone: 510-982-1000
  • Fax: 510-210-9310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: