Healthcare Provider Details

I. General information

NPI: 1386211043
Provider Name (Legal Business Name): RAINA FEISZLI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RAINA HAFFTKA PHD

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 02/13/2022
Certification Date: 02/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 SEA SIDE CT
PLUMAS LAKE CA
95961-8907
US

IV. Provider business mailing address

1810 SEA SIDE CT
PLUMAS LAKE CA
95961-8907
US

V. Phone/Fax

Practice location:
  • Phone: 347-461-3241
  • Fax:
Mailing address:
  • Phone: 347-461-3241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810007490
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: