Healthcare Provider Details

I. General information

NPI: 1043651540
Provider Name (Legal Business Name): RACHEL SARA HERRIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL SARA CARNEY PA-C

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18275 N 59TH AVE STE 144
GLENDALE AZ
85308-1253
US

IV. Provider business mailing address

18275 N 59TH AVE STE 144
GLENDALE AZ
85308-1253
US

V. Phone/Fax

Practice location:
  • Phone: 602-843-2300
  • Fax: 602-843-2310
Mailing address:
  • Phone: 602-843-2300
  • Fax: 602-843-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number5399
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5399
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5399
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: