Provider Demographics
NPI:1477787794
Name:RAINA, ASHUTOSH (MD)
Entity Type:Individual
Prefix:
First Name:ASHUTOSH
Middle Name:
Last Name:RAINA
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 1:5800 STANFORD RANCH RD
Mailing Address - Street 2:BLDG 800
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4385
Mailing Address - Country:US
Mailing Address - Phone:916-259-1099
Mailing Address - Fax:916-758-2924
Practice Address - Street 1:5800 STANFORD RANCH RD
Practice Address - Street 2:BLDG 800
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4385
Practice Address - Country:US
Practice Address - Phone:916-259-1099
Practice Address - Fax:916-758-2924
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1077132084N0400X, 2084N0402X, 2080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities