Provider Demographics
NPI:1023143633
Name:MEDEIROS, RAQUEL M (PA-C)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:M
Last Name:MEDEIROS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:255 N EL CIELO RD
Mailing Address - Street 2:SUITE # 604
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6974
Mailing Address - Country:US
Mailing Address - Phone:760-251-3401
Mailing Address - Fax:760-251-9592
Practice Address - Street 1:12560 PALM DR
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-4559
Practice Address - Country:US
Practice Address - Phone:760-251-3401
Practice Address - Fax:760-251-9592
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA13326363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical