Provider Demographics
NPI:1760616908
Name:FERRARA, RACHEL ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ANNE
Last Name:FERRARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:ANNE
Other - Last Name:SOLOMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 MOODY CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6077
Mailing Address - Country:US
Mailing Address - Phone:805-418-3500
Mailing Address - Fax:805-418-3505
Practice Address - Street 1:100 MOODY CT
Practice Address - Street 2:SUITE 200
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6077
Practice Address - Country:US
Practice Address - Phone:805-418-3500
Practice Address - Fax:805-418-3505
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760616908Medicaid
CAGT276ZMedicare PIN