Provider Demographics
NPI:1215662523
Name:RATTO, JAY N
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:N
Last Name:RATTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 ELM AVE E
Mailing Address - Street 2:
Mailing Address - City:HANSEN
Mailing Address - State:ID
Mailing Address - Zip Code:83334-4938
Mailing Address - Country:US
Mailing Address - Phone:208-251-6729
Mailing Address - Fax:
Practice Address - Street 1:108 TOPONCE DR # 112
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-4717
Practice Address - Country:US
Practice Address - Phone:208-251-6729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant