Provider Demographics
NPI:1174969489
Name:FOSTER, RACHEL GITA (PSYD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:GITA
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:GITA
Other - Last Name:BALDWIN-FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11500 NIMITZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3566
Mailing Address - Country:US
Mailing Address - Phone:424-832-8449
Mailing Address - Fax:
Practice Address - Street 1:1845 ANAHEIM AVE
Practice Address - Street 2:UNIT 9C
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627
Practice Address - Country:US
Practice Address - Phone:310-266-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28670103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical