Healthcare Provider Details

I. General information

NPI: 1881858728
Provider Name (Legal Business Name): RACHEL T PACK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL L TABANGCURA-PACK D.O.

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2552 TORREY PINES RD
LA JOLLA CA
92037-3432
US

IV. Provider business mailing address

PO BOX 7410882
CHICAGO IL
60674-0884
US

V. Phone/Fax

Practice location:
  • Phone: 872-231-3162
  • Fax: 702-977-1496
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A11686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: