Healthcare Provider Details

I. General information

NPI: 1245093319
Provider Name (Legal Business Name): MARIKO C RAJAMAND PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5448 RENO CORPORATE DR
RENO NV
89511-2620
US

IV. Provider business mailing address

5448 RENO CORPORATE DR
RENO NV
89511-2620
US

V. Phone/Fax

Practice location:
  • Phone: 775-993-9292
  • Fax: 775-993-9293
Mailing address:
  • Phone: 775-993-9292
  • Fax: 775-993-9293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARIKO CRUM RAJAMAND
Title or Position: OWNER
Credential: DO
Phone: 775-993-9292