Healthcare Provider Details

I. General information

NPI: 1548064496
Provider Name (Legal Business Name): RACHEL ROSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 GERSON DR
PENN VALLEY PA
19072-1232
US

IV. Provider business mailing address

1616 GERSON DR
PENN VALLEY PA
19072-1232
US

V. Phone/Fax

Practice location:
  • Phone: 610-657-6799
  • Fax:
Mailing address:
  • Phone: 610-657-6799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112767
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: