Provider Demographics
NPI:1619164399
Name:KAUFMAN, RACY ANN (NP)
Entity Type:Individual
Prefix:
First Name:RACY
Middle Name:ANN
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24520 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6800
Mailing Address - Country:US
Mailing Address - Phone:310-303-3181
Mailing Address - Fax:310-303-3948
Practice Address - Street 1:24520 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6800
Practice Address - Country:US
Practice Address - Phone:310-303-3181
Practice Address - Fax:310-303-3948
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA334758163W00000X
CA18197363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse