Healthcare Provider Details

I. General information

NPI: 1538642798
Provider Name (Legal Business Name): RACHANA ALI PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1256
TRACY CA
95378-1256
US

IV. Provider business mailing address

PO BOX 1256
TRACY CA
95378-1256
US

V. Phone/Fax

Practice location:
  • Phone: 510-516-3346
  • Fax:
Mailing address:
  • Phone: 510-516-3346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35068
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: