Healthcare Provider Details

I. General information

NPI: 1710523048
Provider Name (Legal Business Name): RAFAELA LOWE DELEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6126 NE BOTHELL WAY
KENMORE WA
98028-8939
US

IV. Provider business mailing address

1055 E COLORADO BLVD STE 560
PASADENA CA
91106-2380
US

V. Phone/Fax

Practice location:
  • Phone: 888-805-0759
  • Fax:
Mailing address:
  • Phone: 818-241-6780
  • Fax: 818-241-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61504331
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: