Provider Demographics
NPI:1467511394
Name:RATTANAVILAY, JANE
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:
Last Name:RATTANAVILAY
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 1:2235 MOLDAVITE LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-6173
Mailing Address - Country:US
Mailing Address - Phone:707-478-1493
Mailing Address - Fax:
Practice Address - Street 1:1521 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4017
Practice Address - Country:US
Practice Address - Phone:707-478-1493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath