Healthcare Provider Details

I. General information

NPI: 1639631658
Provider Name (Legal Business Name): AMRITA RAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 09/25/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 301 NORTH 21 B. AVENUE
ZUNI NM
87327
US

IV. Provider business mailing address

PO BOX 467
ZUNI NM
87327-0467
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3630
  • Fax:
Mailing address:
  • Phone: 505-782-4431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA180145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: