Healthcare Provider Details

I. General information

NPI: 1508790312
Provider Name (Legal Business Name): RACHEL WIGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1382 BLUE OAKS BLVD STE 213
ROSEVILLE CA
95678-7052
US

IV. Provider business mailing address

8778 SPECTRUM CENTER BLVD APT B426
SAN DIEGO CA
92123-5042
US

V. Phone/Fax

Practice location:
  • Phone: 619-940-5165
  • Fax:
Mailing address:
  • Phone: 951-805-9589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number154243
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: