Healthcare Provider Details

I. General information

NPI: 1093299851
Provider Name (Legal Business Name): RACHEL ROSA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S HIGHLAND AVE STE 204C
LOMBARD IL
60148-6193
US

IV. Provider business mailing address

1919 S HIGHLAND AVE STE 204C
LOMBARD IL
60148-6193
US

V. Phone/Fax

Practice location:
  • Phone: 708-848-4662
  • Fax: 708-613-4319
Mailing address:
  • Phone: 708-848-4662
  • Fax: 708-613-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: