Provider Demographics
NPI:1811213564
Name:FERZOCO, RAINA M (MD)
Entity Type:Individual
Prefix:
First Name:RAINA
Middle Name:M
Last Name:FERZOCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAINA
Other - Middle Name:
Other - Last Name:MAHAJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN: CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1779 DOMINICAN WAY STE B
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1526
Practice Address - Country:US
Practice Address - Phone:831-427-7110
Practice Address - Fax:831-462-1024
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA159773207RH0003X
MN56870207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAENROLLEDMedicaid
MNENROLLEDMedicaid
MNENROLLEDMedicaid