1174805998 NPI number — MONIQUE RACHELL PA-C, OTA/L

NPI Number: 1174805998
Health Care Provider/Practitioner: MONIQUE RACHELL PA-C, OTA/L

NPI Number : 1174805998 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174805998",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RACHELL",
    "FirstName": "MONIQUE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C, OTA/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1991 PINE CREST DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CORONA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92882-3708",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "760-212-1008",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6848 MAGNOLIA AVE STE 220",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RIVERSIDE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92506-2858",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "951-981-2200",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/16/2011",
    "LastUpdateDate": "10/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "67047",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "224Z00000X",
          "TaxonomyName": "Occupational Therapy Assistant",
          "LicenseNumber": "OTA1240",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}