Provider Demographics
NPI:1760535561
Name:MACASAET, RACQUEL ANATALIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:RACQUEL
Middle Name:ANATALIO
Last Name:MACASAET
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19100 VENTURA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3234
Mailing Address - Country:US
Mailing Address - Phone:818-268-1634
Mailing Address - Fax:818-996-6569
Practice Address - Street 1:19100 VENTURA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3234
Practice Address - Country:US
Practice Address - Phone:818-268-1634
Practice Address - Fax:818-996-6569
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice