Healthcare Provider Details

I. General information

NPI: 1558318758
Provider Name (Legal Business Name): RAMI DAKKURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 CHANTICLEER AVE
SANTA CRUZ CA
95065-1815
US

IV. Provider business mailing address

2911 CHANTICLEER AVE
SANTA CRUZ CA
95065-1815
US

V. Phone/Fax

Practice location:
  • Phone: 831-477-2350
  • Fax:
Mailing address:
  • Phone: 831-479-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA96756
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: