Healthcare Provider Details

I. General information

NPI: 1760665095
Provider Name (Legal Business Name): RACHEL DOUGLAS II CMPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 MYERS ST BLDG 3
RIVERSIDE CA
92503-5527
US

IV. Provider business mailing address

3125 MYERS ST BLDG 3
RIVERSIDE CA
92503-5527
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-6895
  • Fax:
Mailing address:
  • Phone: 951-358-6895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-SWBAXT
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: