Provider Demographics
NPI:1568116929
Name:HEINLE, RACHEL ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:HEINLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 DWIGHT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-4422
Mailing Address - Country:US
Mailing Address - Phone:760-695-2987
Mailing Address - Fax:
Practice Address - Street 1:15190 SEGOVIA CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-1219
Practice Address - Country:US
Practice Address - Phone:661-378-2789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB8364248OtherDRIVER LICENSE