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NPI Code Detail

MEDICARE: ROXANA G RAICU M.D.

MEDICARE: ROXANA G RAICU M.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
12084P0800XPsychiatry Physician2003-0100NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972614881
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROXANA G RAICU M.D.
Provider Business Mailing Address
First Line : 4730 BECKNER RD
Second Line :
City : SANTA FE
State : NM
Zip : 87507-4851
Country : US
Telephone Number : 505-989-4500
Fax Number : 505-443-8313
Provider Business Practice Location Address
First Line : 2504 CAMINO ENTRADA
Second Line :
City : SANTA FE
State : NM
Zip : 87507-4851
Country : US
Telephone Number : 505-820-0262
Fax Number : 505-820-9220
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 08/24/2023

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