Provider Demographics
NPI:1508625203
Name:SALAZAR, RAQUEL (LVN)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12136 TRUESDALE ST
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-1333
Mailing Address - Country:US
Mailing Address - Phone:818-915-3796
Mailing Address - Fax:
Practice Address - Street 1:732 MOTT ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4240
Practice Address - Country:US
Practice Address - Phone:818-963-5690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA731873164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse