Healthcare Provider Details

I. General information

NPI: 1477950517
Provider Name (Legal Business Name): RENE MARIE RAZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82675 US HIGHWAY 111
INDIO CA
92201-5635
US

IV. Provider business mailing address

82675 US HIGHWAY 111
INDIO CA
92201-5635
US

V. Phone/Fax

Practice location:
  • Phone: 760-393-3317
  • Fax:
Mailing address:
  • Phone: 760-393-3317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1304161341
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number7725
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: