Healthcare Provider Details

I. General information

NPI: 1942809256
Provider Name (Legal Business Name): RACHEL PRADARELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 N MCDOWELL BLVD
PETALUMA CA
94954-6559
US

IV. Provider business mailing address

261 LAKEVILLE CIR
PETALUMA CA
94954-5720
US

V. Phone/Fax

Practice location:
  • Phone: 707-559-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberG-1918
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: