Healthcare Provider Details

I. General information

NPI: 1881543783
Provider Name (Legal Business Name): RAQUEL CARUNGCONG PPSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 S MORENO DR
BEVERLY HILLS CA
90212-3639
US

IV. Provider business mailing address

6523 FIREBRAND ST
LOS ANGELES CA
90045-1210
US

V. Phone/Fax

Practice location:
  • Phone: 310-551-5100
  • Fax:
Mailing address:
  • Phone: 310-551-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240100689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: