Healthcare Provider Details

I. General information

NPI: 1760326557
Provider Name (Legal Business Name): RAYHERB PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22365 BARTON RD STE 300
GRAND TERRACE CA
92313-5071
US

IV. Provider business mailing address

22365 BARTON RD STE 300
GRAND TERRACE CA
92313-5071
US

V. Phone/Fax

Practice location:
  • Phone: 909-219-5112
  • Fax: 909-219-5159
Mailing address:
  • Phone: 909-219-5112
  • Fax: 909-219-5159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. RACHEL OTUBUAH
Title or Position: PMHNP
Credential: DNP
Phone: 909-219-5119