Healthcare Provider Details

I. General information

NPI: 1780302232
Provider Name (Legal Business Name): RACHA KABBANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 HERNDON AVE
CLOVIS CA
93611-6800
US

IV. Provider business mailing address

9263 N SAYBROOK DR APT 207
FRESNO CA
93720-0822
US

V. Phone/Fax

Practice location:
  • Phone: 281-746-0934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number86378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: