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General NPI Number Information
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NPI Number | 1164524997
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Entity Type | Individual
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Provider Name | LEROY MARIO RASI M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 276 GREEN VALLEY RD
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City | FREEDOM
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State | CA
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Zip | 95019-3112
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Country | US
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Telephone | 831-722-6004
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Fax | 831-722-6036
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Provider Business Mailing Address
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Address Line | 276 GREEN VALLEY RD
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City | FREEDOM
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State | CA
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Zip | 95019-3112
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Country | US
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Telephone | 831-722-6004
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Fax | 831-722-6036
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G86456
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License Number State | CA
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