Healthcare Provider Details

I. General information

NPI: 1811203474
Provider Name (Legal Business Name): RAKESH GADE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 04/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N MCKINLEY ST STE 102
CORONA CA
92879-6593
US

IV. Provider business mailing address

723 ESTANCIA
IRVINE CA
92602-1115
US

V. Phone/Fax

Practice location:
  • Phone: 951-268-9644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60539
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number60539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: