Healthcare Provider Details

I. General information

NPI: 1275024549
Provider Name (Legal Business Name): RACHEL ELISA NEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3182 KAYWOOD DR
ESCONDIDO CA
92026-8411
US

IV. Provider business mailing address

3182 KAYWOOD DR
ESCONDIDO CA
92026-8411
US

V. Phone/Fax

Practice location:
  • Phone: 619-558-4592
  • Fax:
Mailing address:
  • Phone: 619-554-4852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number9
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: