Healthcare Provider Details

I. General information

NPI: 1487488631
Provider Name (Legal Business Name): RACHEL LALA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SOUTH ST
LAKEWOOD CA
90712-1419
US

IV. Provider business mailing address

3700 SOUTH ST
LAKEWOOD CA
90712-1419
US

V. Phone/Fax

Practice location:
  • Phone: 484-388-0656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95023468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: