Healthcare Provider Details

I. General information

NPI: 1053774273
Provider Name (Legal Business Name): RACHEL CASPAR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL NICHOLSON

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 21ST ST
SACRAMENTO CA
95811-5216
US

IV. Provider business mailing address

1500 21ST ST
SACRAMENTO CA
95811-5216
US

V. Phone/Fax

Practice location:
  • Phone: 916-443-3299
  • Fax:
Mailing address:
  • Phone: 916-443-3299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA168974
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10483123-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: