MEDICARE: RACHELLE PANGILINAN R.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	01041125	CA

General Provider Information

NPI Number	:	1972819159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHELLE PANGILINAN R.D

Provider Business Mailing Address
First Line	:	293 N STATE COLLEGE BLVD
Second Line	:	#4079
City	:	ORANGE
State	:	CA
Zip	:	92868-5700
Country	:	US
Telephone Number	:	310-347-9763
Fax Number	:

Provider Business Practice Location Address
First Line	:	293 N STATE COLLEGE BLVD
Second Line	:	#4079
City	:	ORANGE
State	:	CA
Zip	:	92868-5700
Country	:	US
Telephone Number	:	310-347-9763
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	08/25/2010

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