Provider Demographics
NPI:1548833015
Name:MAZUCH, RACHEL
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:MAZUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46-251 LILIPUNA RD
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3645
Mailing Address - Country:US
Mailing Address - Phone:571-442-0620
Mailing Address - Fax:
Practice Address - Street 1:46-251 LILIPUNA RD
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3645
Practice Address - Country:US
Practice Address - Phone:571-442-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician