Provider Demographics
NPI:1275670960
Name:PACKARD, RAE F
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:F
Last Name:PACKARD
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 1:58967 BUSINESS CENTER DRIVE,
Mailing Address - Street 2:#H
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284
Mailing Address - Country:US
Mailing Address - Phone:760-228-9657
Mailing Address - Fax:760-369-6758
Practice Address - Street 1:58967 BUSINESS CENTER DRIVE,
Practice Address - Street 2:#H
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284
Practice Address - Country:US
Practice Address - Phone:760-228-9657
Practice Address - Fax:760-369-6758
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator