Provider Demographics
NPI:1164122230
Name:VASQUEZ, RACHAEL NOEL (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:NOEL
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WOODLAND RD STE 304
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-9562
Mailing Address - Country:US
Mailing Address - Phone:707-963-7200
Mailing Address - Fax:707-963-7203
Practice Address - Street 1:6 WOODLAND RD STE 304
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9562
Practice Address - Country:US
Practice Address - Phone:707-963-7200
Practice Address - Fax:707-963-7203
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027205363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty