Provider Demographics
NPI:1740661586
Name:HECHANOVA, RACHEL LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:HECHANOVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2058 N MILLS AVE
Mailing Address - Street 2:#202
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2812
Mailing Address - Country:US
Mailing Address - Phone:909-973-5361
Mailing Address - Fax:
Practice Address - Street 1:2058 N MILLS AVE
Practice Address - Street 2:#202
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-2812
Practice Address - Country:US
Practice Address - Phone:909-973-5361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52567363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant