Healthcare Provider Details

I. General information

NPI: 1811581689
Provider Name (Legal Business Name): RAQUEL CONCHAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N 14TH ST
SAN JOSE CA
95112-3017
US

IV. Provider business mailing address

1663 MISSION ST STE 250
SAN FRANCISCO CA
94103-2488
US

V. Phone/Fax

Practice location:
  • Phone: 408-771-6574
  • Fax:
Mailing address:
  • Phone: 415-996-8216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: