Healthcare Provider Details

I. General information

NPI: 1982429254
Provider Name (Legal Business Name): RACHAEL DEANN DONAHUE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W LEGION RD
BRAWLEY CA
92227-7780
US

IV. Provider business mailing address

1898 HANFORD DR
SAN DIEGO CA
92111-6736
US

V. Phone/Fax

Practice location:
  • Phone: 760-351-3333
  • Fax:
Mailing address:
  • Phone: 858-353-4786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number65640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: