Healthcare Provider Details

I. General information

NPI: 1881640373
Provider Name (Legal Business Name): DARLENE M RAE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16465 SIERRA LAKES PKWY STE 115
FONTANA CA
92336-1242
US

IV. Provider business mailing address

PO BOX 10069
SAN BERNARDINO CA
92423-0069
US

V. Phone/Fax

Practice location:
  • Phone: 909-823-8000
  • Fax: 909-823-8088
Mailing address:
  • Phone: 909-335-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA55358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: