MEDICARE: ERICA RAQUEDAN

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	363L00000X	Nurse Practitioner	95037491	CA

General Provider Information

NPI Number	:	1629947395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA RAQUEDAN

Provider Business Mailing Address
First Line	:	191 S BUENA VISTA ST STE 340
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4562
Country	:	US
Telephone Number	:	818-559-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 S BUENA VISTA ST STE 340
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4562
Country	:	US
Telephone Number	:	818-559-7500
Fax Number	:

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

Provider Enumeration Date	:	11/01/2025
Last Update Date	:	02/16/2026

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