Provider Demographics
NPI:1902865066
Name:DAS, RAJIB (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RAJIB
Middle Name:
Last Name:DAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:RAJIB
Other - Middle Name:
Other - Last Name:DAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:1934 N WHITEASH AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9509
Mailing Address - Country:US
Mailing Address - Phone:559-217-4936
Mailing Address - Fax:
Practice Address - Street 1:1934 N WHITEASH AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-9509
Practice Address - Country:US
Practice Address - Phone:559-217-4936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17767363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
0PA177672Medicare PIN