Provider Demographics
NPI:1689132011
Name:GARCIA, RACHAEL SUZANNE (DAOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:SUZANNE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4712 ADMIRALTY WAY # 645
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6905
Mailing Address - Country:US
Mailing Address - Phone:215-650-7664
Mailing Address - Fax:
Practice Address - Street 1:11704 WILSHIRE BLVD STE 293
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1541
Practice Address - Country:US
Practice Address - Phone:310-575-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
CA18039171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACERT46962OtherCA MASSAGE THERAPY COUNCIL
CAAC18039OtherCA DEPARTMENT OF CONSUMER AFFAIRS ACUPUNCTURE BOARD