Provider Demographics
NPI:1558590521
Name:IACOBAZZI RIECAN, RACHEL ANTONINA (ND)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANTONINA
Last Name:IACOBAZZI RIECAN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANTONINA
Other - Last Name:IACOBAZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1530 S UNION AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1954
Mailing Address - Country:US
Mailing Address - Phone:253-752-2558
Mailing Address - Fax:253-759-6460
Practice Address - Street 1:1530 S UNION AVE STE 4
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1954
Practice Address - Country:US
Practice Address - Phone:253-752-2558
Practice Address - Fax:253-759-6460
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT61357214175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath