MEDICARE: RAQUEL NELSON CMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173C00000X	Reflexologist

General Provider Information

NPI Number	:	1225416845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL NELSON CMT

Provider Business Mailing Address
First Line	:	PO BOX 11345
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95406-1345
Country	:	US
Telephone Number	:	707-573-3910
Fax Number	:

Provider Business Practice Location Address
First Line	:	3060 CLEVELAND AVE
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2123
Country	:	US
Telephone Number	:	707-573-3910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	05/14/2015

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