Provider Demographics
NPI:1073160081
Name:THIELING, RACQUELLE RANAN TUGADE (NP)
Entity Type:Individual
Prefix:
First Name:RACQUELLE
Middle Name:RANAN TUGADE
Last Name:THIELING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RACQUELLE
Other - Middle Name:RANAN
Other - Last Name:TUGADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5805 SEPULVEDA BLVD STE 690
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2522
Mailing Address - Country:US
Mailing Address - Phone:818-900-6480
Mailing Address - Fax:818-900-6488
Practice Address - Street 1:5805 SEPULVEDA BLVD STE 690
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91411-2522
Practice Address - Country:US
Practice Address - Phone:818-900-6480
Practice Address - Fax:818-900-6488
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95012539363L00000X
CA950125392086S0122X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery