Provider Demographics
NPI:1073071684
Name:ANEKE, RACHEAL EGO
Entity Type:Individual
Prefix:
First Name:RACHEAL
Middle Name:EGO
Last Name:ANEKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3571 MUSTANG DR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-9197
Mailing Address - Country:US
Mailing Address - Phone:909-730-9581
Mailing Address - Fax:
Practice Address - Street 1:9890 COUNTY FARM RD.
Practice Address - Street 2:BUILDING 2
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503
Practice Address - Country:US
Practice Address - Phone:951-509-2499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011152363LP0808X
CANP95011152363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health