Provider Demographics
NPI:1093355166
Name:MUDD, RACHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:MUDD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12865 POINTE DEL MAR WAY STE 160
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3860
Mailing Address - Country:US
Mailing Address - Phone:858-350-7546
Mailing Address - Fax:
Practice Address - Street 1:12865 POINTE DEL MAR WAY STE 160
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3860
Practice Address - Country:US
Practice Address - Phone:858-350-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA60281363A00000X
ORPA197078363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant