Provider Demographics
NPI:1629468053
Name:PHAO, RAQUEL SYLVIA
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:SYLVIA
Last Name:PHAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14508 JUDD ST
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-5023
Mailing Address - Country:US
Mailing Address - Phone:818-730-8922
Mailing Address - Fax:
Practice Address - Street 1:8845 REMICK AVE
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-1739
Practice Address - Country:US
Practice Address - Phone:818-730-8922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program