Provider Demographics
NPI:1609674050
Name:NASCIMENTO, RAINA MICHELLE (RADT)
Entity type:Individual
Prefix:
First Name:RAINA
Middle Name:MICHELLE
Last Name:NASCIMENTO
Suffix:
Gender:
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4443 30TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4288
Mailing Address - Country:US
Mailing Address - Phone:619-597-7335
Mailing Address - Fax:
Practice Address - Street 1:4443 30TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4288
Practice Address - Country:US
Practice Address - Phone:619-597-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1601850225175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist