Healthcare Provider Details

I. General information

NPI: 1215745377
Provider Name (Legal Business Name): RACHEL MARCUS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 MAGNOLIA AVE STE 2A
CORONA CA
92879-3122
US

IV. Provider business mailing address

2960 CHAMPION WAY APT 1307
TUSTIN CA
92782-1215
US

V. Phone/Fax

Practice location:
  • Phone: 951-736-8144
  • Fax:
Mailing address:
  • Phone: 502-475-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95032681
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1158951
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95230406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: