Healthcare Provider Details

I. General information

NPI: 1174332845
Provider Name (Legal Business Name): RACHEL ALFRED IRUDAYARAJ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 S SEPULVEDA BLVD STE 100
LOS ANGELES CA
90064-1744
US

IV. Provider business mailing address

1333 VALLEY VIEW RD APT 30
GLENDALE CA
91202-1734
US

V. Phone/Fax

Practice location:
  • Phone: 800-426-6467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: