Provider Demographics
NPI:1174805998
Name:RACHELL, MONIQUE (PA-C, OTA/L)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:RACHELL
Suffix:
Gender:F
Credentials:PA-C, OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 PINE CREST DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3708
Mailing Address - Country:US
Mailing Address - Phone:760-212-1008
Mailing Address - Fax:
Practice Address - Street 1:8133 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3409
Practice Address - Country:US
Practice Address - Phone:951-688-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CAOTA1240224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant