Active NPI
Rae F Packard
- Rehabilitation Practitioner
- Yucca Valley, CA
National Provider Identifier
1275670960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 58967 Business Center Drive,
#H
Yucca Valley, CA 92284 - Phone
- (760) 228-9657
- Fax
- (760) 369-6758
- NPI assigned
- Jan 31, 2007
- 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 | |||
| Rehabilitation Practitioner | 225400000X | Primary |
Addresses
Primary practice location
58967 Business Center Drive,
#H
Yucca Valley, CA 92284
Mailing address
58967 Business Center Drive,
#H
Yucca Valley, CA 92284
Phone (760) 228-9657
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": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256169600000",
"number": "1275670960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "58967 BUSINESS CENTER DRIVE,",
"address_2": "#H",
"city": "YUCCA VALLEY",
"state": "CA",
"postal_code": "92284",
"telephone_number": "760-228-9657",
"fax_number": "760-369-6758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "58967 BUSINESS CENTER DRIVE,",
"address_2": "#H",
"city": "YUCCA VALLEY",
"state": "CA",
"postal_code": "92284",
"telephone_number": "760-228-9657",
"fax_number": "760-369-6758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACKARD",
"first_name": "RAE",
"middle_name": "F",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-31",
"last_updated": "2009-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yucca Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.