Provider Demographics
NPI:1043696917
Name:TACHE, RACHELLE BLISS (NP-C)
Entity type:Individual
Prefix:MS
First Name:RACHELLE
Middle Name:BLISS
Last Name:TACHE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:BLISS
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RACHEL BLISS CRUZ
Mailing Address - Street 1:127 S SAN VICENTE BLVD # A6600
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3311
Mailing Address - Country:US
Mailing Address - Phone:424-315-2360
Mailing Address - Fax:
Practice Address - Street 1:127 S SAN VICENTE BLVD # A6600
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3311
Practice Address - Country:US
Practice Address - Phone:424-315-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily