Healthcare Provider Details

I. General information

NPI: 1891833216
Provider Name (Legal Business Name): RACHEL LA MADRID BALBAS-GO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14659 OLIVE VIEW DR
SYLMAR CA
91342-1652
US

IV. Provider business mailing address

659 E GARDENIA DR
AZUSA CA
91702-6296
US

V. Phone/Fax

Practice location:
  • Phone: 818-485-0888
  • Fax:
Mailing address:
  • Phone: 626-812-0497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP23011
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number541990
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number541990
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: