Basic Information
| Provider Information | |||||||||
| NPI: | 1275010241 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEDINA | ||||||||
| FirstName: | RACHEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13193 CENTRAL AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917104179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099029111 | ||||||||
| FaxNumber: | 9099029199 | ||||||||
| Practice Location | |||||||||
| Address1: | 13193 CENTRAL AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917104179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099029111 | ||||||||
| FaxNumber: | 9099029199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2018 | ||||||||
| LastUpdateDate: | 07/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 95009499 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.