Provider Demographics
NPI:1437439262
Name:DERN, RACHEL ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ELAINE
Last Name:DERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 SUTTER PL
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6201
Practice Address - Country:US
Practice Address - Phone:916-262-9414
Practice Address - Fax:916-262-9420
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13918170-1205207V00000X
NV50157207V00000X
PAMT199509207V00000X
AZ50157207V00000X
CAC194597207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology