Healthcare Provider Details

I. General information

NPI: 1790217453
Provider Name (Legal Business Name): RAYNE MCLOUGHLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 PINO SOLO DR
SANTA MARIA CA
93455-5601
US

IV. Provider business mailing address

1249 PINO SOLO DR
SANTA MARIA CA
93455-5601
US

V. Phone/Fax

Practice location:
  • Phone: 805-934-6334
  • Fax: 805-934-6381
Mailing address:
  • Phone: 805-934-6334
  • Fax: 805-934-6381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: