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General NPI Number Information
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NPI Number | 1073011193
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Entity Type | Individual
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Provider Name | RACHEL RENEE CLISER NP
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Gender | Female
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 02/07/2020
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Provider Practice Location Address
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Address Line | 188 E 17TH ST STE 101
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City | COSTA MESA
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State | CA
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Zip | 92627-3702
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Country | US
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Telephone | 949-515-4548
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Fax |
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Provider Business Mailing Address
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Address Line | 220 OLD NEWPORT BLVD
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-4135
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Country | US
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Telephone | 909-240-8970
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95006030
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License Number State | CA
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