Healthcare Provider Details

I. General information

NPI: 1477269637
Provider Name (Legal Business Name): RAYNA VINSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 06/30/2024
Certification Date: 06/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W LINCOLN AVE STE 105
ANAHEIM CA
92805-2928
US

IV. Provider business mailing address

801 E KATELLA AVE
ANAHEIM CA
92805-6614
US

V. Phone/Fax

Practice location:
  • Phone: 714-922-4100
  • Fax:
Mailing address:
  • Phone: 714-922-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number62251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: