Provider Demographics
NPI:1225529076
Name:MATIAS, RACHELLE GRACE (DACM, LOM)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:GRACE
Last Name:MATIAS
Suffix:
Gender:F
Credentials:DACM, LOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2315
Mailing Address - Country:US
Mailing Address - Phone:323-578-6950
Mailing Address - Fax:
Practice Address - Street 1:306 S NEW ST STE 205
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1652
Practice Address - Country:US
Practice Address - Phone:484-953-3253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-28
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000243171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist