Provider Demographics
NPI:1619520665
Name:TUNGOL, RACHEL
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:TUNGOL
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 1:7149 TANAGER DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-5035
Mailing Address - Country:US
Mailing Address - Phone:925-719-6913
Mailing Address - Fax:
Practice Address - Street 1:7149 TANAGER DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-5035
Practice Address - Country:US
Practice Address - Phone:925-719-6913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2024-10-29
Deactivation Date:2024-10-21
Deactivation Code:
Reactivation Date:2024-10-28
Provider Licenses
StateLicense IDTaxonomies
CA95032623363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care