Active NPI
Destiny Rae Razo
- Rehabilitation Practitioner
- Los Banos, CA
National Provider Identifier
1114602075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 40 W G St
Los Banos, CA 93635-3657 - Phone
- (209) 381-6800
- Fax
- (209) 725-3963
- NPI assigned
- Jun 19, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | CA | ||
| Rehabilitation Practitioner | 225400000X | CA | Primary |
Addresses
Primary practice location
40 W G St
Los Banos, CA 93635-3657
Mailing address
545 M St
Los Banos, CA 93635-4234
Phone (209) 752-4823
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749427200000",
"number": "1114602075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "545 M ST",
"city": "LOS BANOS",
"state": "CA",
"postal_code": "936354234",
"telephone_number": "209-752-4823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 W G ST",
"city": "LOS BANOS",
"state": "CA",
"postal_code": "936353657",
"telephone_number": "209-381-6800",
"fax_number": "209-725-3963"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAZO",
"first_name": "DESTINY",
"middle_name": "RAE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-19",
"last_updated": "2025-06-09",
"certification_date": "2025-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Los Banos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.