Healthcare Provider Details

I. General information

NPI: 1801420021
Provider Name (Legal Business Name): RACHEL LOUISE REAGAN RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 S ANITA DR STE 201
ORANGE CA
92868-3346
US

IV. Provider business mailing address

265 S ANITA DR STE 201
ORANGE CA
92868-3346
US

V. Phone/Fax

Practice location:
  • Phone: 714-410-3505
  • Fax: 714-410-3529
Mailing address:
  • Phone: 714-410-3505
  • Fax: 714-410-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN95146060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: