Healthcare Provider Details

I. General information

NPI: 1407995244
Provider Name (Legal Business Name): MRS. RACHELLE SALDANA SUPPIPHATVONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S HARBOR BLVD STE 400
ANAHEIM CA
92805-3743
US

IV. Provider business mailing address

222 S HARBOR BLVD STE 400
ANAHEIM CA
92805-3743
US

V. Phone/Fax

Practice location:
  • Phone: 714-517-6300
  • Fax:
Mailing address:
  • Phone: 714-517-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number71103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: