Healthcare Provider Details

I. General information

NPI: 1447018791
Provider Name (Legal Business Name): TEMOORE RAJA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 CITY CENTRAL AVE
CONROE TX
77304-2981
US

IV. Provider business mailing address

18422 MADISONS CROSSING LN
TOMBALL TX
77375-7622
US

V. Phone/Fax

Practice location:
  • Phone: 936-202-5202
  • Fax:
Mailing address:
  • Phone: 713-775-9767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: