Healthcare Provider Details

I. General information

NPI: 1427764976
Provider Name (Legal Business Name): RACHEL L WINN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 PACIFIC HWY
SAN DIEGO CA
92101-2429
US

IV. Provider business mailing address

8565 MILBURY ROAD N/A
SAN DIEGO CA
92129
US

V. Phone/Fax

Practice location:
  • Phone: 858-694-3900
  • Fax:
Mailing address:
  • Phone: 858-603-1526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95058792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: