Provider Demographics
NPI:1083737613
Name:COLE RAUB, ANDREA (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:COLE RAUB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:317 N EL CAMINO REAL STE 101
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2812
Mailing Address - Country:US
Mailing Address - Phone:760-633-1315
Mailing Address - Fax:760-633-1393
Practice Address - Street 1:561 SAXONY PL
Practice Address - Street 2:SUITE 101
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-633-1315
Practice Address - Fax:760-633-1393
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2017-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A59662083P0500X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F21449Medicare UPIN