Basic Information
| Provider Information | |||||||||
| NPI: | 1407995244 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUPPIPHATVONG | ||||||||
| FirstName: | RACHELLE | ||||||||
| MiddleName: | SALDANA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14140 BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926834453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148967566 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14140 BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926834453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148967566 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 71103 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.