Healthcare Provider Details

I. General information

NPI: 1659965259
Provider Name (Legal Business Name): JONATHAN RANEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-7000
  • Fax: 415-924-2661
Mailing address:
  • Phone: 415-925-7000
  • Fax: 415-924-2661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number59382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: