Healthcare Provider Details

I. General information

NPI: 1306667522
Provider Name (Legal Business Name): RACHEL ZOSIA TOWNSEND KEKUA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 MERCURY WAY STE 240
SANTA ROSA CA
95407-5443
US

IV. Provider business mailing address

2235 MERCURY WAY STE 240
SANTA ROSA CA
95407-5443
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-3778
  • Fax:
Mailing address:
  • Phone: 707-570-3778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: