Provider Demographics
NPI:1053759357
Name:CROSS, RACHELLE Q (NP-C)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:Q
Last Name:CROSS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:
Other - Last Name:QUIMPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:393 E WALNUT ST FL 3
Mailing Address - Street 2:PHR GROUP PROVIDER ENROLLMENT UNIT
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91188-0001
Mailing Address - Country:US
Mailing Address - Phone:877-608-0044
Mailing Address - Fax:877-514-0903
Practice Address - Street 1:19353 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91335-6302
Practice Address - Country:US
Practice Address - Phone:562-866-3892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22751363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily