Provider Demographics
NPI:1487082145
Name:BOVALINA, RACHEL L (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:L
Last Name:BOVALINA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:CHICHILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 OXFORD DR STE 211
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1898
Mailing Address - Country:US
Mailing Address - Phone:412-283-0260
Mailing Address - Fax:412-283-0070
Practice Address - Street 1:2000 OXFORD DR STE 211
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102
Practice Address - Country:US
Practice Address - Phone:412-283-0260
Practice Address - Fax:412-283-0070
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056528363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103226130Medicaid
PA103226130Medicaid