Healthcare Provider Details

I. General information

NPI: 1205238797
Provider Name (Legal Business Name): PERRY R RANKIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 E 6TH ST
MADERA CA
93638-3631
US

IV. Provider business mailing address

4911 E RICHMOND AVE
CLOVIS CA
93619-4700
US

V. Phone/Fax

Practice location:
  • Phone: 559-664-4158
  • Fax:
Mailing address:
  • Phone: 559-273-8194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number61724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: