Provider Demographics
NPI:1669523049
Name:NANAKUL, RAWI
Entity type:Individual
Prefix:MR
First Name:RAWI
Middle Name:
Last Name:NANAKUL
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 1:1659 DREW CIR APT 2090
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-7812
Mailing Address - Country:US
Mailing Address - Phone:408-386-2177
Mailing Address - Fax:
Practice Address - Street 1:2750 N TEXAS ST STE 430
Practice Address - Street 2:CA 94533
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-1290
Practice Address - Country:US
Practice Address - Phone:707-429-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor