Healthcare Provider Details

I. General information

NPI: 1174477574
Provider Name (Legal Business Name): ARVA DANIELLE RACKLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 SAN PABLO AVE SUITE 31
BERKELEY CA
94702
US

IV. Provider business mailing address

PO BOX 2465
BERKELEY CA
94702-0465
US

V. Phone/Fax

Practice location:
  • Phone: 510-500-5169
  • Fax:
Mailing address:
  • Phone: 510-500-5169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberL9940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: