Healthcare Provider Details

I. General information

NPI: 1447557178
Provider Name (Legal Business Name): RAE MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6454 PONY EXPRESS TRL SUITE 33
POLLOCK PINES CA
95726-9652
US

IV. Provider business mailing address

PO BOX 1343
PLACERVILLE CA
95667-1343
US

V. Phone/Fax

Practice location:
  • Phone: 916-715-4317
  • Fax:
Mailing address:
  • Phone: 916-715-4317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number047113
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number047113
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number047113
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number047113
License Number StateCA

VIII. Authorized Official

Name: MRS. LINDA RAE LORDEN
Title or Position: CEO
Credential: RN
Phone: 916-715-4317