Provider Demographics
NPI:1831981034
Name:LUANGRATH, RACHELL ANN ABAD (NP)
Entity type:Individual
Prefix:
First Name:RACHELL ANN
Middle Name:ABAD
Last Name:LUANGRATH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:RACHELL ANN
Other - Middle Name:B
Other - Last Name:ABAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1316 WYCKOFF ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3519
Mailing Address - Country:US
Mailing Address - Phone:228-596-5004
Mailing Address - Fax:
Practice Address - Street 1:1316 WYCKOFF ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3519
Practice Address - Country:US
Practice Address - Phone:228-596-5004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032036363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology