1770012221 NPI number — ROSALIND SHEILA RAYNOR

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 1770012221 NPI number — ROSALIND SHEILA RAYNOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAYNOR
Provider First Name:
ROSALIND
Provider Middle Name:
SHEILA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAYNOR
Provider Other First Name:
ROSALIND
Provider Other Middle Name:
SHEILA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1770012221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4900 CANADA VALLEY RD APT 114
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANTIOCH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94531-8156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-238-4259
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GOLDEN HILLS COUNSELING CENTER
Provider Second Line Business Practice Location Address:
2401 SHADY WILLOW LN.
Provider Business Practice Location Address City Name:
BRENTWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-516-0653
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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