Provider Demographics
NPI:1699398594
Name:RASTAD, JOHN (LVN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:RASTAD
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 RIVER TRAILS CIR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2222
Mailing Address - Country:US
Mailing Address - Phone:202-288-8222
Mailing Address - Fax:
Practice Address - Street 1:2201 RIVER TRAILS CIR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2222
Practice Address - Country:US
Practice Address - Phone:202-288-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293027164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse