Healthcare Provider Details

I. General information

NPI: 1083326763
Provider Name (Legal Business Name): RACHEL HANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 RUFFIN RD STE 100
SAN DIEGO CA
92123-1893
US

IV. Provider business mailing address

3702 RUFFIN RD STE 100
SAN DIEGO CA
92123-1893
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-4300
  • Fax: 619-297-4400
Mailing address:
  • Phone: 619-297-4300
  • Fax: 619-297-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number17912
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2828550
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: