Provider Demographics
NPI:1053084004
Name:JUMONVILLE, RACHEL (PA-C, MMS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:JUMONVILLE
Suffix:
Gender:F
Credentials:PA-C, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RUE TOULOUSE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4681
Mailing Address - Country:US
Mailing Address - Phone:337-278-8729
Mailing Address - Fax:
Practice Address - Street 1:9301 WILSHIRE BLVD STE 405A
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-6139
Practice Address - Country:US
Practice Address - Phone:310-299-8959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA59835363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant