Healthcare Provider Details

I. General information

NPI: 1295235380
Provider Name (Legal Business Name): ANNA M. RAINVILLE M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 W VERMONT AVE
ESCONDIDO CA
92025-6584
US

IV. Provider business mailing address

17701 SAN PASQUAL VALLEY RD
ESCONDIDO CA
92025-5301
US

V. Phone/Fax

Practice location:
  • Phone: 760-480-2255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number124472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: