Organization Name: | DR RACHEL MAYORGA MD PC |
NPI Number: | 1255738613 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RACHEL MAYORGA (PRESIDENT) |
Mailing Address: | 810 Healdsburg Ave Healdsburg |
State: | CA US |
Postal Code: | 954483613 |
Phone Number: | 6304429740 |
Fax Number: | |
NPI Enumeration Date: | 12/01/2014 |
NPI Last Update Date: | 12/01/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |