Provider Demographics
NPI:1154038073
Name:CHANDRA, RAJESH (MS SLP)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:
Last Name:CHANDRA
Suffix:
Gender:M
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 N SAN ANSELMO ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95391-1208
Mailing Address - Country:US
Mailing Address - Phone:510-350-6575
Mailing Address - Fax:
Practice Address - Street 1:19700 HESPERIAN BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4704
Practice Address - Country:US
Practice Address - Phone:510-785-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty