Healthcare Provider Details

I. General information

NPI: 1740676964
Provider Name (Legal Business Name): RACHEL MOEBUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

IV. Provider business mailing address

1250 E MARSHALL ST BOX 980146
RICHMOND VA
23298-5051
US

V. Phone/Fax

Practice location:
  • Phone: 916-843-7000
  • Fax: 168-437-1379
Mailing address:
  • Phone: 804-628-4368
  • Fax: 804-828-8299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME145227
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: