Healthcare Provider Details

I. General information

NPI: 1730819855
Provider Name (Legal Business Name): JULIA RAQUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 S LOOP W STE 595
HOUSTON TX
77054-5618
US

IV. Provider business mailing address

2656 S LOOP W STE 595
HOUSTON TX
77054-5618
US

V. Phone/Fax

Practice location:
  • Phone: 346-800-6001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number903230
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1076086
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1076086
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: