Provider Demographics
NPI:1215745377
Name:MARCUS, RACHEL (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MARCUS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 CHAMPION WAY APT 1307
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1215
Mailing Address - Country:US
Mailing Address - Phone:502-475-3311
Mailing Address - Fax:
Practice Address - Street 1:770 MAGNOLIA AVE STE 2A
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3122
Practice Address - Country:US
Practice Address - Phone:951-736-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1158951163W00000X
CA95230406163W00000X
CA95032681363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse