Provider Demographics
NPI:1053394809
Name:RASCON, RICHARD VAL (FNP AND PA)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:VAL
Last Name:RASCON
Suffix:
Gender:M
Credentials:FNP AND PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2260 RALSTON RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-4651
Mailing Address - Country:US
Mailing Address - Phone:916-359-4117
Mailing Address - Fax:916-973-7750
Practice Address - Street 1:2016 MORSE AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2135
Practice Address - Country:US
Practice Address - Phone:916-973-7750
Practice Address - Fax:916-973-7739
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10203363A00000X
CA241526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP26794/ZZZ20265ZMedicare UPIN