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General NPI Number Information
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NPI Number | 1689138299
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Entity Type | Individual
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Provider Name | CHANDA RANKIN PHD
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Gender | Female
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Dates
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Enumeration Date | 01/28/2019
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Last Update Date | 11/15/2019
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Provider Practice Location Address
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Address Line | 7 4TH ST STE 52
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City | PETALUMA
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State | CA
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Zip | 94952-7410
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Country | US
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Telephone | 310-980-9163
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Fax |
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Provider Business Mailing Address
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Address Line | 1179 N MCDOWELL BLVD
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City | PETALUMA
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State | CA
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Zip | 94954-6559
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Country | US
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Telephone | 707-559-7500
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Fax | 707-559-7620
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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