Healthcare Provider Details

I. General information

NPI: 1932085289
Provider Name (Legal Business Name): RACHEL NEEDHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39001 SUNDALE DR
FREMONT CA
94538-2005
US

IV. Provider business mailing address

4501 CARLYLE CT APT 1312
SANTA CLARA CA
95054-3925
US

V. Phone/Fax

Practice location:
  • Phone: 510-796-1100
  • Fax:
Mailing address:
  • Phone: 510-512-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: