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General NPI Number Information
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NPI Number | 1861860009
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Entity Type | Individual
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Provider Name | MS. RAQUEL MARIE ARELLANO-JACKSON
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Gender | Female
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 1461 E COOLEY DR SUITE 100
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City | COLTON
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State | CA
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Zip | 92324
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Country | US
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Telephone | 909-904-9757
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Fax |
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Provider Business Mailing Address
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Address Line | 1461 E COOLEY DR SUITE 100
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City | COLTON
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State | CA
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Zip | 92324-3921
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Country | US
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Telephone | 909-904-9757
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ASW68536
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 84193
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License Number State | CA
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