Basic Information
| Provider Information | |||||||||
| NPI: | 1164612990 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RHOADES | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1531 PLUMAS CT | ||||||||
| Address2: | SUITE B | ||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959912966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307514900 | ||||||||
| FaxNumber: | 5307514901 | ||||||||
| Practice Location | |||||||||
| Address1: | 1908 N BEALE RD STE E | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959016937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307436888 | ||||||||
| FaxNumber: | 5307439823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2007 | ||||||||
| LastUpdateDate: | 04/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 363AM0700X | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | MR1642164 | 01 | CA | DEA | OTHER | 19345 | 01 | CA | PA-C | OTHER |