=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942394275
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACINTHA L RAJ MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 09/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1020 S 40TH AVE SUITE C
-----------------------------------------------------
City | YAKIMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98908-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-966-3969
-----------------------------------------------------
Fax | 509-966-3979
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1020 S 40TH AVE SUITE C
-----------------------------------------------------
City | YAKIMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98908-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-966-3969
-----------------------------------------------------
Fax | 509-966-3979
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | MD00044674
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------