Healthcare Provider Details

I. General information

NPI: 1457205072
Provider Name (Legal Business Name): RECELITO TRAU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 STANAFORD RD
BECKLEY WV
25801-3142
US

IV. Provider business mailing address

8272 MEDEIROS WAY
SACRAMENTO CA
95829-8163
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: