Provider Demographics
NPI:1457750119
Name:RAINBOLT, PAUL JEFFREY (NP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JEFFREY
Last Name:RAINBOLT
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:JEFFREY
Other - Last Name:LEILANI-RAINBOLT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:410 VIA EL ENCANTADOR
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2736
Mailing Address - Country:US
Mailing Address - Phone:323-500-0826
Mailing Address - Fax:
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:323-500-0826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAF362328759363LA2100X
CAF070519286363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine