Healthcare Provider Details

I. General information

NPI: 1013337997
Provider Name (Legal Business Name): RACHEL BODE-KESLER RASI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2844 COLOMA ST 19
PLACERVILLE CA
95667-4406
US

IV. Provider business mailing address

2848 SCHNELL SCHOOL RD 19
PLACERVILLE CA
95667-4900
US

V. Phone/Fax

Practice location:
  • Phone: 530-626-9240
  • Fax:
Mailing address:
  • Phone: 530-919-1394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: