MEDICARE: RAQUEL J NEIDHOLD M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	51513	CA

General Provider Information

NPI Number	:	1568501971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL J NEIDHOLD M.S.

Provider Business Mailing Address
First Line	:	PO BOX 74189
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-0189
Country	:	US
Telephone Number	:	213-639-2661
Fax Number	:	213-389-1987

Provider Business Practice Location Address
First Line	:	2500 WILSHIRE BLVD
Second Line	:	SUITE 704
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4303
Country	:	US
Telephone Number	:	213-639-2661
Fax Number	:	213-389-1987

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	06/14/2012

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