Healthcare Provider Details

I. General information

NPI: 1902557192
Provider Name (Legal Business Name): DR. RACHEL ASHIOKAI OTUBUAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21060 TELEGRAPH RD
RIVERSIDE CA
92507-0049
US

IV. Provider business mailing address

3357 CHICAGO AVE
RIVERSIDE CA
92507-6814
US

V. Phone/Fax

Practice location:
  • Phone: 909-844-9908
  • Fax:
Mailing address:
  • Phone: 951-452-2731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95019674
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: