Healthcare Provider Details

I. General information

NPI: 1144625245
Provider Name (Legal Business Name): RAYLENE KNIGHT CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RAYLENE LOOMIS

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4322 E JANICE WAY
PHOENIX AZ
85032-8101
US

IV. Provider business mailing address

4322 E JANICE WAY
PHOENIX AZ
85032-8101
US

V. Phone/Fax

Practice location:
  • Phone: 508-341-5153
  • Fax: 844-733-5163
Mailing address:
  • Phone: 508-341-5153
  • Fax: 844-733-5163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number112783
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: