Provider Demographics
NPI:1831267228
Name:RAUEN, KATHERINE A (M D)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:RAUEN
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 50TH ST RM 2284
Mailing Address - Street 2:UC DAVIS MIND INSTITUTE
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2310
Mailing Address - Country:US
Mailing Address - Phone:916-703-0382
Mailing Address - Fax:
Practice Address - Street 1:2825 50TH ST RM 2284
Practice Address - Street 2:UC DAVIS MIND INSTITUTE
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2310
Practice Address - Country:US
Practice Address - Phone:916-703-0382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60658207SG0201X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A606580Medicaid
CA00A606580Medicaid
CA00A606580Medicare ID - Type UnspecifiedMEDI-CAL PIN