MEDICARE: RACHAEL KATINA BRANCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician	16383-166-853-0001	TX

General Provider Information

NPI Number	:	1326829011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL KATINA BRANCH

Provider Business Mailing Address
First Line	:	200 ENGRACIA DR APT H6
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-5879
Country	:	US
Telephone Number	:	414-379-1817
Fax Number	:

Provider Business Practice Location Address
First Line	:	1302 WATSON BLVD # 1009
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-3436
Country	:	US
Telephone Number	:	478-210-2237
Fax Number	:	602-536-5248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2023
Last Update Date	:	10/10/2023

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