Healthcare Provider Details

I. General information

NPI: 1235614447
Provider Name (Legal Business Name): ANNIA WAHEED RAJA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 OCEAN PARK BLVD STE 630
SANTA MONICA CA
90405-3004
US

IV. Provider business mailing address

3019 OCEAN PARK BLVD STE 630
SANTA MONICA CA
90405-3004
US

V. Phone/Fax

Practice location:
  • Phone: 213-373-4949
  • Fax:
Mailing address:
  • Phone: 213-373-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number37973
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: