Healthcare Provider Details

I. General information

NPI: 1902206063
Provider Name (Legal Business Name): RACHEL LLANES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4849 SCHUYLER AVENUE
LA MESA CA
91941
US

IV. Provider business mailing address

4849 SCHUYLER AVE
LA MESA CA
91941-3920
US

V. Phone/Fax

Practice location:
  • Phone: 619-797-7226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number81160
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: