Provider Demographics
NPI:1255983292
Name:FISCHBACH, RACHEL BLOSSOM
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:BLOSSOM
Last Name:FISCHBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 LAURELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4636
Mailing Address - Country:US
Mailing Address - Phone:805-908-2492
Mailing Address - Fax:
Practice Address - Street 1:5741 LAS VIRGENES RD
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1272
Practice Address - Country:US
Practice Address - Phone:818-712-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician