Healthcare Provider Details

I. General information

NPI: 1639242001
Provider Name (Legal Business Name): ELENA RAPOPORT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 VILLAGE CENTER DR STE 111
GRANITE BAY CA
95746-6313
US

IV. Provider business mailing address

4120 DOUGLAS BLVD # 306-341
GRANITE BAY CA
95746-5936
US

V. Phone/Fax

Practice location:
  • Phone: 916-695-9131
  • Fax: 916-474-4527
Mailing address:
  • Phone: 916-915-3695
  • Fax: 949-203-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA84954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: