Healthcare Provider Details

I. General information

NPI: 1891669990
Provider Name (Legal Business Name): HENRY RAFFERTY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 CAPRICORN WAY STE 210
SANTA ROSA CA
95407-5486
US

IV. Provider business mailing address

2227 CAPRICORN WAY STE 210
SANTA ROSA CA
95407-5486
US

V. Phone/Fax

Practice location:
  • Phone: 707-656-4868
  • Fax:
Mailing address:
  • Phone: 707-656-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number28436
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: