Healthcare Provider Details

I. General information

NPI: 1609447523
Provider Name (Legal Business Name): RACHEL E GENTILLON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL E WILZBACH

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CONCORD AVE STE 185
CONCORD CA
94520-5006
US

IV. Provider business mailing address

475 W 260 N
OREM UT
84057-1970
US

V. Phone/Fax

Practice location:
  • Phone: 575-489-6651
  • Fax:
Mailing address:
  • Phone: 801-221-9930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA.BA.70055504
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: