Healthcare Provider Details

I. General information

NPI: 1457750119
Provider Name (Legal Business Name): PAUL JEFFREY RAINBOLT NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PAUL JEFFREY LEILANI-RAINBOLT NP

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

410 VIA EL ENCANTADOR
SANTA BARBARA CA
93111-2736
US

V. Phone/Fax

Practice location:
  • Phone: 323-500-0826
  • Fax:
Mailing address:
  • Phone: 323-500-0826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF362328759
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberF070519286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: