Provider Demographics
NPI:1396239117
Name:ALVAREZ, RACHAEL REBUJIO (PA-C)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:REBUJIO
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:ELISABETH
Other - Last Name:REBUJIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1331 E COMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-3401
Mailing Address - Country:US
Mailing Address - Phone:310-763-4250
Mailing Address - Fax:
Practice Address - Street 1:1331 E COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3401
Practice Address - Country:US
Practice Address - Phone:310-763-4250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA55748363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant