Provider Demographics
NPI:1720289374
Name:RAKOSKI, MINA OH (MD)
Entity type:Individual
Prefix:DR
First Name:MINA
Middle Name:OH
Last Name:RAKOSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25865 BARTON RD
Mailing Address - Street 2:STE 101
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3895
Mailing Address - Country:US
Mailing Address - Phone:909-558-3364
Mailing Address - Fax:
Practice Address - Street 1:25865 BARTON RD
Practice Address - Street 2:STE 101
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3895
Practice Address - Country:US
Practice Address - Phone:909-558-3364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96170207R00000X, 207RT0003X, 207RG0100X
MI4301092770207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology