Healthcare Provider Details

I. General information

NPI: 1841152642
Provider Name (Legal Business Name): RACHELLE LIANA FREDERICKS LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHELLE LIANA DELVA

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 N MAGNOLIA AVE
EL CAJON CA
92020-3906
US

IV. Provider business mailing address

234 N MAGNOLIA AVE
EL CAJON CA
92020-3906
US

V. Phone/Fax

Practice location:
  • Phone: 619-579-8373
  • Fax: 619-579-8155
Mailing address:
  • Phone: 619-579-8373
  • Fax: 619-579-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number730872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: