Healthcare Provider Details

I. General information

NPI: 1780593178
Provider Name (Legal Business Name): ELASHA MARIE RACKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 43RD ST STE 62
OAKLAND CA
94609-2138
US

IV. Provider business mailing address

490 43RD ST STE 62
OAKLAND CA
94609-2138
US

V. Phone/Fax

Practice location:
  • Phone: 707-373-6188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number94029809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: