Healthcare Provider Details

I. General information

NPI: 1154787919
Provider Name (Legal Business Name): DR. RACHEL CIVEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 N FIGUEROA ST # 212
LOS ANGELES CA
90012-2602
US

IV. Provider business mailing address

313 N FIGUEROA ST # 212
LOS ANGELES CA
90012-2602
US

V. Phone/Fax

Practice location:
  • Phone: 213-250-8653
  • Fax:
Mailing address:
  • Phone: 213-250-8653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG68895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: