Provider Demographics
NPI:1841256989
Name:HRABKO, RANDALL P (MD)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:P
Last Name:HRABKO
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:PO BOX 4180
Mailing Address - Street 2:
Mailing Address - City:CLEARLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95422-4180
Mailing Address - Country:US
Mailing Address - Phone:707-701-4211
Mailing Address - Fax:
Practice Address - Street 1:6880 PALM AVENUE
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472
Practice Address - Country:US
Practice Address - Phone:707-823-7628
Practice Address - Fax:707-823-1521
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39326207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G393260Medicaid
CA1841256989OtherNPI
CA1841256989OtherNPI
CA00G393260Medicaid
CA00G393261Medicare PIN