=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174656615
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HARMANDEEP SINGH RAI PA-C,MPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1524 MCHENRY AVE SUITE 500
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95350-4500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-979-9949
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6832 SALVATERRA CIR
-----------------------------------------------------
City | ELK GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95757-3486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-524-9986
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA 19006
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------