Basic Information
| Provider Information | |||||||||
| NPI: | 1003308958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLINE | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | L | ||||||||
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| OtherLastName: | LUNA | ||||||||
| OtherFirstName: | RACHEL | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1600 PROVIDENCE DR | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767072261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2543134200 | ||||||||
| FaxNumber: | 2543134549 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 NE STALLINGS DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | NACOGDOCHES | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759652111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365598770 | ||||||||
| FaxNumber: | 9365598773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2018 | ||||||||
| LastUpdateDate: | 09/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | BP10063982 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.