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General NPI Number Information
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NPI Number | 1174805998
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Entity Type | Individual
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Provider Name | MONIQUE RACHELL PA-C, OTA/L
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Gender | Female
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 6848 MAGNOLIA AVE STE 220
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City | RIVERSIDE
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State | CA
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Zip | 92506-2858
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Country | US
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Telephone | 951-981-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 1991 PINE CREST DR
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City | CORONA
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State | CA
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Zip | 92882-3708
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Country | US
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Telephone | 760-212-1008
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 67047
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA1240
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License Number State | CA
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