Provider Demographics
NPI:1427385988
Name:RAINA, ACHLA (MD)
Entity Type:Individual
Prefix:
First Name:ACHLA
Middle Name:
Last Name:RAINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 MOWRY AVE
Mailing Address - Street 2:#400
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1730
Mailing Address - Country:US
Mailing Address - Phone:510-284-4100
Mailing Address - Fax:510-794-9783
Practice Address - Street 1:1860 MOWRY AVE
Practice Address - Street 2:#400
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1730
Practice Address - Country:US
Practice Address - Phone:510-284-4100
Practice Address - Fax:510-794-9783
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A899200Medicaid