Healthcare Provider Details

I. General information

NPI: 1720555634
Provider Name (Legal Business Name): RACHEL UPTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 N LAKE AVE
PASADENA CA
91104-4596
US

IV. Provider business mailing address

2333 LAKE AVE FL 2
ALTADENA CA
91001-2463
US

V. Phone/Fax

Practice location:
  • Phone: 626-798-0706
  • Fax:
Mailing address:
  • Phone: 626-794-5737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95175848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: