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Individual

RAJU MANTENA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O

Contact information

Practice address
1724 RICHMOND AVE, HOUSTON, TX 77098
(832) 783-9100
(832) 783-9101
Mailing address
337 GARDEN OAKS BLVD # 51007, HOUSTON, TX 77018-5501
(713) 597-5131
(855) 835-6461

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
227337
NY
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
227337
NY
207LP2900X
Pain Medicine (Anesthesiology) Physician
227337
NY
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
P4780
TX
208VP0000X
Pain Medicine Physician
227337
NY
208VP0014X
Interventional Pain Medicine Physician
227337
NY
208VP0014X
Interventional Pain Medicine Physician
P4780
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02458588
NY
01
8HS306
BCBS TX
TX
Enumeration date
06/24/2005
Last updated
01/03/2019
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