Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 43554 | CA |
NPI | 1043458169 |
---|---|
Provider Name | Dr. Debora Rayhan |
First Address | Santa Rosa, CA 95409-5372 |
Second Address | Santa Rosa, CA 95409-5372 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2009 |
Last Update Date | 27/01/2009 |