Provider Demographics
NPI:1588600068
Name:RAJU, MINA (DO)
Entity type:Individual
Prefix:DR
First Name:MINA
Middle Name:
Last Name:RAJU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2744
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93279-2744
Mailing Address - Country:US
Mailing Address - Phone:559-302-7927
Mailing Address - Fax:559-741-9938
Practice Address - Street 1:5400 W HILLSDALE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-8222
Practice Address - Country:US
Practice Address - Phone:559-302-7927
Practice Address - Fax:559-741-9938
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9970207RI0200X
CT044291207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX99700Medicaid
I56612Medicare UPIN
020A99700Medicare PIN