Healthcare Provider Details

I. General information

NPI: 1578668117
Provider Name (Legal Business Name): RACHEL BARANCO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 COMPTON AVE
LOS ANGELES CA
90002-3628
US

IV. Provider business mailing address

8475 S VAN NESS AVE STE 106
INGLEWOOD CA
90305-1565
US

V. Phone/Fax

Practice location:
  • Phone: 323-564-4331
  • Fax: 323-563-1636
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA050813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: