Healthcare Provider Details

I. General information

NPI: 1477840049
Provider Name (Legal Business Name): RACHEL M. CHOLULA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17671 IRVINE BLVD STE 218
TUSTIN CA
92780-3129
US

IV. Provider business mailing address

600 W SANTA ANA BLVD STE 530
SANTA ANA CA
92701-4551
US

V. Phone/Fax

Practice location:
  • Phone: 949-281-6238
  • Fax:
Mailing address:
  • Phone: 714-253-7877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: