Provider Demographics
NPI:1912240912
Name:FACIO, RACHEL VICTORIA
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:VICTORIA
Last Name:FACIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N CENTRAL AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4262
Mailing Address - Country:US
Mailing Address - Phone:818-660-5307
Mailing Address - Fax:
Practice Address - Street 1:715 N CENTRAL AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4262
Practice Address - Country:US
Practice Address - Phone:818-660-5307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist