Provider Demographics
NPI:1467679258
Name:RISCHETTE, RANDY MICHENER (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:MICHENER
Last Name:RISCHETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 PHAROAHS LANE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-9499
Mailing Address - Country:US
Mailing Address - Phone:707-829-3235
Mailing Address - Fax:
Practice Address - Street 1:103 MORRIS STREET
Practice Address - Street 2:SUITE G
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-9499
Practice Address - Country:US
Practice Address - Phone:707-524-4431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA5549202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry