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General NPI Number Information
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NPI Number | 1629032503
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Entity Type | Individual
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Provider Name | JENNIFER RACCA M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 75 PRINGLE WAY STE 701
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City | RENO
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State | NV
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Zip | 89502-1472
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Country | US
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Telephone | 775-982-5000
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Fax | 775-982-3900
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Provider Business Mailing Address
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Address Line | 1155 MILL ST # MS 14
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City | RENO
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State | NV
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Zip | 89502-1576
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Country | US
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Telephone | 775-982-5262
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Fax | 775-982-5437
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 10617
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 10617
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License Number State | NV
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