Healthcare Provider Details

I. General information

NPI: 1962325787
Provider Name (Legal Business Name): ANGELICA RANGEL RAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 JOSEPH CT
SAN RAFAEL CA
94903-2664
US

IV. Provider business mailing address

30 JOSEPH CT
SAN RAFAEL CA
94903-2664
US

V. Phone/Fax

Practice location:
  • Phone: 415-785-4993
  • Fax: 415-599-4362
Mailing address:
  • Phone: 415-785-4993
  • Fax: 415-599-4362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: