Healthcare Provider Details

I. General information

NPI: 1205448917
Provider Name (Legal Business Name): RACHEL SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 SPRUCE ST SUITE A
RIVERSIDE CA
92507
US

IV. Provider business mailing address

10281 KIDD ST
RIVERSIDE CA
92503-3469
US

V. Phone/Fax

Practice location:
  • Phone: 951-715-5050
  • Fax:
Mailing address:
  • Phone: 951-715-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-VNASRT
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: