Basic Information
| Provider Information | |||||||||
| NPI: | 1578852307 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REBONG | ||||||||
| FirstName: | RACHELLE | ||||||||
| MiddleName: | ARJONA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1850 SULLIVAN AVE | ||||||||
| Address2: | STE 540 | ||||||||
| City: | DALY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940152215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507556900 | ||||||||
| FaxNumber: | 6507552107 | ||||||||
| Practice Location | |||||||||
| Address1: | 2351 CLAY ST STE 380 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941151931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156003954 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2011 | ||||||||
| LastUpdateDate: | 01/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | A124449 | CA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.