Provider Demographics
NPI:1184840209
Name:ROBERT A RACHAL
Entity Type:Organization
Organization Name:ROBERT A RACHAL
Other - Org Name:VALLEY HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:RACHAL
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:760-379-5532
Mailing Address - Street 1:PO BOX 2955
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:CA
Mailing Address - Zip Code:93240-2955
Mailing Address - Country:US
Mailing Address - Phone:760-379-5532
Mailing Address - Fax:
Practice Address - Street 1:6040 B LAKE ISABELLA BLVD
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240
Practice Address - Country:US
Practice Address - Phone:760-379-5532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA0030350237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherSSN
CAHA0030350Medicaid
CAHA3035OtherLICENSE