Healthcare Provider Details

I. General information

NPI: 1013311349
Provider Name (Legal Business Name): RAJENDRA KEWALLAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 S. STEVENSON CT.
VISALIA CA
93277
US

IV. Provider business mailing address

3319 S. STEVENSON CT.
VISALIA CA
93277
US

V. Phone/Fax

Practice location:
  • Phone: 559-905-9626
  • Fax:
Mailing address:
  • Phone: 559-905-9626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: