Healthcare Provider Details

I. General information

NPI: 1487973798
Provider Name (Legal Business Name): SNEHAL RAISONI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIWGHWAY 162 AND BIGGAR LANE
COVELO CA
95428-0247
US

IV. Provider business mailing address

PO BOX 0247 HIGHWAY 162 AND BIGGAR LANE
COVELO CA
95428-0247
US

V. Phone/Fax

Practice location:
  • Phone: 707-983-6181
  • Fax: 707-983-6802
Mailing address:
  • Phone: 707-983-6181
  • Fax: 707-983-6802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number63206-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: