Healthcare Provider Details

I. General information

NPI: 1457952137
Provider Name (Legal Business Name): ANEESH REMANI RAVI DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANEESH REMANIRAVI

II. Dates (important events)

Enumeration Date: 11/08/2020
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

IV. Provider business mailing address

9340 CAMADA CT
ELK GROVE CA
95624-2030
US

V. Phone/Fax

Practice location:
  • Phone: 916-366-5443
  • Fax:
Mailing address:
  • Phone: 219-299-0552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-3078
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95040608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: