Provider Demographics
NPI:1831286426
Name:RAESE, JOACHIM D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOACHIM
Middle Name:D
Last Name:RAESE
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 1:1100 S AKERS ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8311
Mailing Address - Country:US
Mailing Address - Phone:707-266-4436
Mailing Address - Fax:
Practice Address - Street 1:1100 S.AKERS STREEY
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:707-266-4436
Practice Address - Fax:559-635-6377
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A339902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
330965207OtherHMO PPO INSURANCE
CA330965207Medicaid
CA330965207Medicaid
330965207OtherHMO PPO INSURANCE