Provider Demographics
NPI:1134156649
Name:DOUGLASS, RACHELLE JEANNEA (MD)
Entity type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:JEANNEA
Last Name:DOUGLASS
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:PO BOX 11177
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1177
Mailing Address - Country:US
Mailing Address - Phone:816-289-0533
Mailing Address - Fax:
Practice Address - Street 1:7901 WALKER ST
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1722
Practice Address - Country:US
Practice Address - Phone:714-670-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104586207P00000X
MO2008009980207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine