Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 18428 | CA |
Y | 207Q00000X | Family Doctor | 18428 | CA |
NPI | 1629488366 |
---|---|
Provider Name | Dr. Nathan Rheault |
First Address | Salinas, CA 93901-2260 |
Second Address | Santa Cruz, CA 95060-4561 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2014 |
Last Update Date | 20/09/2021 |