Healthcare Provider Details

I. General information

NPI: 1144522152
Provider Name (Legal Business Name): MR. MANUEL RAQUEL II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 SERRANIA AVE
WOODLAND HILLS CA
91364-3301
US

IV. Provider business mailing address

4900 SERRANIA AVE
WOODLAND HILLS CA
91364-3301
US

V. Phone/Fax

Practice location:
  • Phone: 818-347-1577
  • Fax: 818-347-0184
Mailing address:
  • Phone: 818-347-1577
  • Fax: 818-347-0184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN246143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: