Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A91332 | CA |
N | 208600000X | Surgeon | A91332 | CA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | A91332 | CA |
NPI | 1023030319 |
---|---|
Provider Name | Todd Coleman Rau |
First Address | Redlands, CA 92373-3911 |
Second Address | Redlands, CA 92373-3911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 15/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I45839 | (02) | CA |