Healthcare Provider Details

I. General information

NPI: 1861770737
Provider Name (Legal Business Name): HARINI RACHERLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 STONE BLVD #6M
WEST SACRAMENTO CA
95691-4044
US

IV. Provider business mailing address

18 OUTER BANKS PL #6M
SACRAMENTO CA
95835-2469
US

V. Phone/Fax

Practice location:
  • Phone: 917-704-7844
  • Fax:
Mailing address:
  • Phone: 917-704-7844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number#390200000X
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA133840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: