Provider Demographics
NPI:1700011335
Name:VALLEJO, RACHEL (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:VALLEJO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 MADISON AVE W
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-2200
Mailing Address - Country:US
Mailing Address - Phone:239-658-3064
Mailing Address - Fax:239-658-3175
Practice Address - Street 1:1284 CREEKSIDE ST
Practice Address - Street 2:#101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1949
Practice Address - Country:US
Practice Address - Phone:239-596-3133
Practice Address - Fax:239-591-2154
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 107591207Q00000X
FLME107591207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine