Healthcare Provider Details

I. General information

NPI: 1962510198
Provider Name (Legal Business Name): SANDRA ELIZABETH RAYNER AUD, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 EXPOSITION BLVD BLDG 700
SACRAMENTO CA
95815-4314
US

IV. Provider business mailing address

1111 EXPOSITION BLVD BLDG 700
SACRAMENTO CA
95815-4314
US

V. Phone/Fax

Practice location:
  • Phone: 916-736-3404
  • Fax: 916-233-4171
Mailing address:
  • Phone: 916-736-3404
  • Fax: 916-233-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberSR000207
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: