Provider Demographics
NPI:1346529310
Name:SULLIVAN, RACHEL MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:MARIE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:MARIE
Other - Last Name:HARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2510 AIRPARK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2461
Mailing Address - Country:US
Mailing Address - Phone:530-244-4034
Mailing Address - Fax:530-244-1821
Practice Address - Street 1:2510 AIRPARK DR STE 201
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2461
Practice Address - Country:US
Practice Address - Phone:530-244-4034
Practice Address - Fax:530-244-1821
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA130463207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program