Healthcare Provider Details

I. General information

NPI: 1629488366
Provider Name (Legal Business Name): NATHAN RHEAULT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 FRONT ST STE 345B
SANTA CRUZ CA
95060-4561
US

IV. Provider business mailing address

1212 S MAIN ST
SALINAS CA
93901-2260
US

V. Phone/Fax

Practice location:
  • Phone: 831-419-6446
  • Fax:
Mailing address:
  • Phone: 831-422-7777
  • Fax: 831-422-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18428
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number18428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: