Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 36106287 | IL |
NPI | 1124078365 |
---|---|
Provider Name | Dr. Rachel Mayorga |
First Address | Healdsburg, CA 95448-3367 |
Second Address | Healdsburg, CA 95448-3367 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 28/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036106287 | (05) | IL |
208341 | MEDICARE GROUP NUMBER (01) | IL |
208342 | MEDICARE GROUP NUMBER (01) | IL |
H87236 | (02) | IL |
P01804275 | RAILROAD MEDICARE (01) | CA |