Provider Demographics
NPI:1124699855
Name:ABDON, RALAINE (NP)
Entity type:Individual
Prefix:
First Name:RALAINE
Middle Name:
Last Name:ABDON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RALAINE
Other - Middle Name:
Other - Last Name:GUYAMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9410 QUESNEL CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-1046
Mailing Address - Country:US
Mailing Address - Phone:916-710-1034
Mailing Address - Fax:
Practice Address - Street 1:8233 E STOCKTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-8203
Practice Address - Country:US
Practice Address - Phone:916-313-8433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-03
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017716363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty