Healthcare Provider Details

I. General information

NPI: 1831132810
Provider Name (Legal Business Name): RODNEY M BRAUHER LMSW, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 RIVER PARK DR STE 260
SACRAMENTO CA
95815-4504
US

IV. Provider business mailing address

5781 GRAND RIVER DR
GRAND LEDGE MI
48837-8958
US

V. Phone/Fax

Practice location:
  • Phone: 657-400-5180
  • Fax:
Mailing address:
  • Phone: 517-622-2912
  • Fax: 517-622-2912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801059465
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: