1427168186 NPI number — RALEYS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427168186 NPI number — RALEYS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RALEYS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427168186
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 WEST CAPITOL AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95605-2696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-373-6394
Provider Business Mailing Address Fax Number:
916-372-6226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3550 NORTH G STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERCED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95348-0691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-722-3853
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SINGMASTER
Authorized Official First Name:
HELEN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
916-373-6394

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY53503 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0510001 . This is a "NABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1427168186 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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