Healthcare Provider Details

I. General information

NPI: 1871507830
Provider Name (Legal Business Name): RASHMI JAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 WESTON
IRVINE CA
92620-2190
US

IV. Provider business mailing address

82 WESTON
IRVINE CA
92620-2190
US

V. Phone/Fax

Practice location:
  • Phone: 817-564-5750
  • Fax: 817-612-3268
Mailing address:
  • Phone: 817-564-5750
  • Fax: 817-612-3268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA87620
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM4538
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: