Provider Demographics
NPI:1942681655
Name:CETTA, RACHEL LAUREN (DO)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LAUREN
Last Name:CETTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 HARVEST HILL RD STE 290
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-5826
Mailing Address - Country:US
Mailing Address - Phone:214-420-0650
Mailing Address - Fax:214-736-0512
Practice Address - Street 1:14155 N 83RD AVE STE 110
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5640
Practice Address - Country:US
Practice Address - Phone:623-215-0911
Practice Address - Fax:623-215-0912
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007839207N00000X
MI5101022011207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty