Healthcare Provider Details

I. General information

NPI: 1578294625
Provider Name (Legal Business Name): KAYLA NICOLE RASMUSSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BROADWAY
OAKLAND CA
94612-2004
US

IV. Provider business mailing address

1400 BROADWAY
OAKLAND CA
94612-2004
US

V. Phone/Fax

Practice location:
  • Phone: 877-855-7526
  • Fax:
Mailing address:
  • Phone: 877-855-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28684
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA192039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: