Provider Demographics
NPI:1215657846
Name:RAKKAR, JASBEEN KAUR
Entity type:Individual
Prefix:
First Name:JASBEEN
Middle Name:KAUR
Last Name:RAKKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 MCCALL DR
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3932
Mailing Address - Country:US
Mailing Address - Phone:707-315-4082
Mailing Address - Fax:
Practice Address - Street 1:2415 HIGH SCHOOL AVE STE 800
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1858
Practice Address - Country:US
Practice Address - Phone:925-687-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPA63863363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program