Provider Demographics
NPI:1154553733
Name:RAIKAR, PRIYANKA (OTR/L)
Entity type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:
Last Name:RAIKAR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:PRIANKA
Other - Middle Name:
Other - Last Name:DHARGALKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3658 BARHAM BLVD APT P206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1387
Mailing Address - Country:US
Mailing Address - Phone:818-763-0136
Mailing Address - Fax:
Practice Address - Street 1:6400 LAUREL CANYON BLVD STE 400
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1564
Practice Address - Country:US
Practice Address - Phone:818-763-0136
Practice Address - Fax:818-763-3838
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT10720174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist