Provider Demographics
NPI:1851682264
Name:FORD, RACHEL SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:SUZANNE
Last Name:FORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:SUZANNE
Other - Last Name:MELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24687 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9591
Mailing Address - Country:US
Mailing Address - Phone:951-506-1040
Mailing Address - Fax:951-506-1044
Practice Address - Street 1:24687 MONROE AVE
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9591
Practice Address - Country:US
Practice Address - Phone:951-506-1040
Practice Address - Fax:951-506-1044
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA122480208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program