Basic Information
Provider Information
NPI: 1679700967
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAO
FirstName: SWATI
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2230 STOCKTON BLVD
Address2:  
City: SACRAMENTO
State: CA
PostalCode: 95817
CountryCode: US
TelephoneNumber: 9167345612
FaxNumber: 9167343384
Practice Location
Address1: 2130 STOCKTON BLVD
Address2:  
City: SACRAMENTO
State: CA
PostalCode: 95817
CountryCode: US
TelephoneNumber: 9168750701
FaxNumber: 9168765615
Other Information
ProviderEnumerationDate: 06/15/2009
LastUpdateDate: 04/13/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XA116652CAN Allopathic & Osteopathic PhysiciansFamily Medicine 
2084P0800XA116652CAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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