Healthcare Provider Details

I. General information

NPI: 1295062214
Provider Name (Legal Business Name): RACHNA RAWAL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12675 LA MIRADA BLVD STE 200
LA MIRADA CA
90638-2200
US

IV. Provider business mailing address

12675 LA MIRADA BLVD STE 200
LA MIRADA CA
90638-2200
US

V. Phone/Fax

Practice location:
  • Phone: 562-944-8054
  • Fax: 562-946-5324
Mailing address:
  • Phone: 562-944-8054
  • Fax: 562-946-5324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA82575
License Number StateCA

VIII. Authorized Official

Name: DR. RACHNA RAWAL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 562-944-8054