Provider Demographics
NPI:1154098929
Name:MACAM, RACHEL HANNAH FLORES (RD)
Entity Type:Individual
Prefix:MS
First Name:RACHEL HANNAH
Middle Name:FLORES
Last Name:MACAM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE STE 570
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1229
Mailing Address - Country:US
Mailing Address - Phone:858-457-4917
Mailing Address - Fax:
Practice Address - Street 1:9850 GENESEE AVE STE 570
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1229
Practice Address - Country:US
Practice Address - Phone:858-457-4917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered