Provider Demographics
NPI:1063004281
Name:RAUDA, MARCEL ENRIQUE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARCEL
Middle Name:ENRIQUE
Last Name:RAUDA
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 E HOLT BLVD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-1850
Mailing Address - Country:US
Mailing Address - Phone:818-572-3988
Mailing Address - Fax:
Practice Address - Street 1:32605 TEMECULA PKWY STE 202
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6838
Practice Address - Country:US
Practice Address - Phone:858-427-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016623363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health