Healthcare Provider Details

I. General information

NPI: 1144753914
Provider Name (Legal Business Name): RACHAEL MARIE CARRENO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W FLORENCE AVE
LOS ANGELES CA
90044-6105
US

IV. Provider business mailing address

2727 N MAIN PLACE DR UNIT 546
SANTA ANA CA
92705-6071
US

V. Phone/Fax

Practice location:
  • Phone: 323-789-5610
  • Fax:
Mailing address:
  • Phone: 603-380-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A24745
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO203600
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: