Provider Demographics
NPI:1992991863
Name:DUBRIA, M. RACHEL (PA)
Entity type:Individual
Prefix:
First Name:M.
Middle Name:RACHEL
Last Name:DUBRIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5953 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-3133
Mailing Address - Country:US
Mailing Address - Phone:323-562-6170
Mailing Address - Fax:323-562-6176
Practice Address - Street 1:5953 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-3133
Practice Address - Country:US
Practice Address - Phone:323-562-6170
Practice Address - Fax:323-562-6176
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14801363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant