Provider Demographics
NPI:1831267822
Name:RACZKO, CYNTHIA S (OTR)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:S
Last Name:RACZKO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-2911
Mailing Address - Country:US
Mailing Address - Phone:707-678-6717
Mailing Address - Fax:916-614-4210
Practice Address - Street 1:1650 RESPONSE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4807
Practice Address - Country:US
Practice Address - Phone:916-614-4206
Practice Address - Fax:916-614-4210
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4814174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist