Healthcare Provider Details

I. General information

NPI: 1740045582
Provider Name (Legal Business Name): MS. RACHAEL ARLENE BASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E SAN JACINTO AVE
PERRIS CA
92570-2878
US

IV. Provider business mailing address

308 E SAN JACINTO AVE
PERRIS CA
92570-2878
US

V. Phone/Fax

Practice location:
  • Phone: 951-439-1689
  • Fax: 951-704-7864
Mailing address:
  • Phone: 951-439-1689
  • Fax: 951-704-7864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-DLIMJT
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: