Healthcare Provider Details

I. General information

NPI: 1659580207
Provider Name (Legal Business Name): LINDA A RAKE PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 UNIVERSITY ST
HEALDSBURG CA
95448
US

IV. Provider business mailing address

1381 UNIVERSITY ST
HEALDSBURG CA
95448-3314
US

V. Phone/Fax

Practice location:
  • Phone: 707-433-5494
  • Fax: 707-431-8649
Mailing address:
  • Phone: 707-433-5494
  • Fax: 707-431-8649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 13290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: