Provider Demographics
NPI:1033279609
Name:YNCHAUSTI, RAQUEL M (MD)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:M
Last Name:YNCHAUSTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 N HACIENDA BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1143
Mailing Address - Country:US
Mailing Address - Phone:626-850-5056
Mailing Address - Fax:626-850-5059
Practice Address - Street 1:1840 N HACIENDA BLVD STE 4
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1143
Practice Address - Country:US
Practice Address - Phone:626-850-5056
Practice Address - Fax:626-850-5059
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38952208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A389520Medicaid