Healthcare Provider Details

I. General information

NPI: 1730909730
Provider Name (Legal Business Name): RACHEL NICOLE SOUSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8432 MAGNOLIA AVE
RIVERSIDE CA
92504-3206
US

IV. Provider business mailing address

5059 QUAIL RUN RD APT 140
RIVERSIDE CA
92507-6487
US

V. Phone/Fax

Practice location:
  • Phone: 925-368-8001
  • Fax:
Mailing address:
  • Phone: 925-368-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: