Healthcare Provider Details

I. General information

NPI: 1669914065
Provider Name (Legal Business Name): RACHEL OURIEFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E BETTERAVIA RD #C
SANTA MARIA CA
93454-7847
US

IV. Provider business mailing address

1040 RIDGECREST PL
NIPOMO CA
93444-9404
US

V. Phone/Fax

Practice location:
  • Phone: 805-614-9000
  • Fax:
Mailing address:
  • Phone: 425-457-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number53826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: