MEDICARE: MISS INDHUSHREE S. RAJAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY30808	CA

General Provider Information

NPI Number	:	1205084027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS INDHUSHREE S. RAJAN PH.D.

Provider Business Mailing Address
First Line	:	5132 MAPLEWOOD AVE APT 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-1583
Country	:	US
Telephone Number	:	714-402-8101
Fax Number	:

Provider Business Practice Location Address
First Line	:	433 N CAMDEN DR FL 4
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4408
Country	:	US
Telephone Number	:	424-285-3547
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	01/04/2021

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