Provider Demographics
NPI:1912193301
Name:GIANFORTUNE, RACHEL MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MICHELLE
Last Name:GIANFORTUNE
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 1:8881 FLETCHER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3135
Mailing Address - Country:US
Mailing Address - Phone:619-464-6434
Mailing Address - Fax:619-464-5109
Practice Address - Street 1:8881 FLETCHER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3135
Practice Address - Country:US
Practice Address - Phone:619-464-6434
Practice Address - Fax:619-464-5109
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94327208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA94327OtherMEDICAL BOARD