Healthcare Provider Details

I. General information

NPI: 1033984794
Provider Name (Legal Business Name): NANCY LAXAMANA RAFANAN ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9890 COUNTY FARM RD STE 2
RIVERSIDE CA
92503-3678
US

IV. Provider business mailing address

39525 LOS ALAMOS RD STE C #424
MURRIETA CA
92563
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-2499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: