Healthcare Provider Details

I. General information

NPI: 1962413625
Provider Name (Legal Business Name): DUSTIN A RABER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 W LACEY BLVD SUITE 205
HANFORD CA
93230-5965
US

IV. Provider business mailing address

PO BOX 906
HANFORD CA
93232-0906
US

V. Phone/Fax

Practice location:
  • Phone: 559-583-4507
  • Fax: 559-583-4686
Mailing address:
  • Phone: 559-587-4115
  • Fax: 559-587-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA94854
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: