Healthcare Provider Details

I. General information

NPI: 1285898999
Provider Name (Legal Business Name): RACHEL S BASULTO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL SOARES PA-C

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7420 GREENHAVEN DR STE 130
SACRAMENTO CA
95831-5164
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD STE 100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 916-399-6015
  • Fax: 916-394-3344
Mailing address:
  • Phone: 800-972-5547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: