Provider Demographics
NPI:1518620871
Name:SIEGEL, RACHEL ANNE (NP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANNE
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANNE
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:629 IDAHO AVE APT 23
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2770
Mailing Address - Country:US
Mailing Address - Phone:414-531-8081
Mailing Address - Fax:
Practice Address - Street 1:21750 CENTER COURT DR S
Practice Address - Street 2:SUITE 650
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703
Practice Address - Country:US
Practice Address - Phone:414-531-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018545363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology