Healthcare Provider Details

I. General information

NPI: 1679110837
Provider Name (Legal Business Name): RACHEL RENEE LEAL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19330 JESSE LN STE 280
RIVERSIDE CA
92508-5076
US

IV. Provider business mailing address

19330 JESSE LN STE 280
RIVERSIDE CA
92508-5076
US

V. Phone/Fax

Practice location:
  • Phone: 951-387-4040
  • Fax: 951-398-3144
Mailing address:
  • Phone: 951-387-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number113305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: