Provider Demographics
NPI:1225416845
Name:NELSON, RAQUEL (CMT)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11345
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95406-1345
Mailing Address - Country:US
Mailing Address - Phone:707-573-3910
Mailing Address - Fax:
Practice Address - Street 1:3060 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2123
Practice Address - Country:US
Practice Address - Phone:707-573-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist