Healthcare Provider Details

I. General information

NPI: 1114134053
Provider Name (Legal Business Name): GABRIELLE D. RASI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6357 COYLE AVE STE B
CARMICHAEL CA
95608-0438
US

IV. Provider business mailing address

6357 COYLE AVE STE B
CARMICHAEL CA
95608-0438
US

V. Phone/Fax

Practice location:
  • Phone: 916-961-1111
  • Fax: 916-961-8811
Mailing address:
  • Phone: 916-961-1111
  • Fax: 916-961-8811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number40808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: