Individual
TAJ RAZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2825 WALDENS POND CV, LONGWOOD, FL 32779-7037
(407) 829-6666
Mailing address
2825 WALDENS POND CV, LONGWOOD, FL 32779-7037
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6906510
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004286200
—
FL
Enumeration date
02/18/2013
Last updated
02/18/2013
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