Provider Demographics
NPI:1972376531
Name:RECINTO, RACHELLE P
Entity type:Individual
Prefix:MS
First Name:RACHELLE
Middle Name:P
Last Name:RECINTO
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 1:8729 EAGLES ROOST RD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93907-9214
Mailing Address - Country:US
Mailing Address - Phone:831-421-1317
Mailing Address - Fax:831-319-4028
Practice Address - Street 1:99 AIRPORT BLVD STE B
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-2917
Practice Address - Country:US
Practice Address - Phone:831-319-4190
Practice Address - Fax:831-319-4028
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445202713310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility