=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578676755
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GUNA RAJ M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2006
-----------------------------------------------------
Last Update Date | 03/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 COIT RD STE 209
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-6172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-759-7999
-----------------------------------------------------
Fax | 469-758-2272
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17311 DALLAS PKWY STE 240
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75248-1150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-759-7999
-----------------------------------------------------
Fax | 469-758-2272
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | H3146
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------