Provider Demographics
NPI:1790217453
Name:MCLOUGHLIN, RAYNE
Entity Type:Individual
Prefix:
First Name:RAYNE
Middle Name:
Last Name:MCLOUGHLIN
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 1:1249 PINO SOLO DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5601
Mailing Address - Country:US
Mailing Address - Phone:805-934-6334
Mailing Address - Fax:805-934-6381
Practice Address - Street 1:1249 PINO SOLO DR
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5601
Practice Address - Country:US
Practice Address - Phone:805-934-6334
Practice Address - Fax:805-934-6381
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker