Healthcare Provider Details

I. General information

NPI: 1659090231
Provider Name (Legal Business Name): RACHEL ABUCASIS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11645 WILSHIRE BLVD # 601
LOS ANGELES CA
90025-1708
US

IV. Provider business mailing address

11645 WILSHIRE BLVD # 601
LOS ANGELES CA
90025-1708
US

V. Phone/Fax

Practice location:
  • Phone: 301-909-0180
  • Fax:
Mailing address:
  • Phone: 310-909-0180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3719
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number8776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: