Healthcare Provider Details

I. General information

NPI: 1396239117
Provider Name (Legal Business Name): RACHAEL REBUJIO ALVAREZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHAEL ELISABETH REBUJIO PA-C

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S LONG BEACH BLVD
COMPTON CA
90221-3423
US

IV. Provider business mailing address

121 S LONG BEACH BLVD
COMPTON CA
90221-3423
US

V. Phone/Fax

Practice location:
  • Phone: 310-627-5850
  • Fax: 310-627-5855
Mailing address:
  • Phone: 310-627-5850
  • Fax: 310-627-5855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA55748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: