Healthcare Provider Details

I. General information

NPI: 1912934472
Provider Name (Legal Business Name): RACINE EDWARDS-SILVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL # FE16
MADERA CA
93636-8761
US

IV. Provider business mailing address

PO BOX 699
MOUNTAIN HOME TN
37684-0699
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-6700
  • Fax: 559-353-6710
Mailing address:
  • Phone: 423-433-6039
  • Fax: 423-433-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number54560
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC2452
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number54560
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG87527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: