Healthcare Provider Details

I. General information

NPI: 1396624185
Provider Name (Legal Business Name): SELF LOVE MENTAL HEALTH & WELLNESS NURSING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6809 INDIANA AVE STE 130-C22
RIVERSIDE CA
92506-4221
US

IV. Provider business mailing address

6809 INDIANA AVE STE 130-C22
RIVERSIDE CA
92506-4221
US

V. Phone/Fax

Practice location:
  • Phone: 951-633-8466
  • Fax:
Mailing address:
  • Phone: 951-633-8466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: RAQUEL BRACAMONTES
Title or Position: CEO/FOUNDER
Credential: PMHNP-BC, MSN, RN
Phone: 951-633-8466