Provider Demographics
NPI:1104216126
Name:RAI, AMRITA
Entity Type:Individual
Prefix:MS
First Name:AMRITA
Middle Name:
Last Name:RAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 RIMPAU AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-2693
Mailing Address - Country:US
Mailing Address - Phone:909-910-4294
Mailing Address - Fax:
Practice Address - Street 1:1411 RIMPAU AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-2693
Practice Address - Country:US
Practice Address - Phone:909-910-4294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS243281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical