Healthcare Provider Details

I. General information

NPI: 1649985615
Provider Name (Legal Business Name): RACHEL DETIENNE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 ORANGE TREE LN STE 100
REDLANDS CA
92374-4588
US

IV. Provider business mailing address

39686 CORTE GATA
MURRIETA CA
92562-4373
US

V. Phone/Fax

Practice location:
  • Phone: 909-674-1199
  • Fax:
Mailing address:
  • Phone: 951-505-3819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: