Healthcare Provider Details

I. General information

NPI: 1639414360
Provider Name (Legal Business Name): RACHEAL KATHERINE KERR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 N PERRIS BLVD STE G5-G6
PERRIS CA
92571-2509
US

IV. Provider business mailing address

PO BOX 549
LAKE ELSINORE CA
92531-0549
US

V. Phone/Fax

Practice location:
  • Phone: 951-294-5870
  • Fax: 951-294-5806
Mailing address:
  • Phone: 951-294-5870
  • Fax: 951-294-5806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: