MEDICARE: RAQUEL RASCON B.A., BCABA

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	103K00000X	Behavior Analyst	0-13-5653	CA

General Provider Information

NPI Number	:	1225454598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL RASCON B.A., BCABA

Provider Business Mailing Address
First Line	:	1223 EL PRADO AVE
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-2708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 EL PRADO AVE
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-2708
Country	:	US
Telephone Number	:	310-320-5856
Fax Number	:

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

Provider Enumeration Date	:	03/11/2014
Last Update Date	:	03/11/2014

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