Provider Demographics
NPI:1770597809
Name:HENDERSON, RAQUEL MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:MARIE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W HIGHLAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-3855
Mailing Address - Country:US
Mailing Address - Phone:909-886-7576
Mailing Address - Fax:
Practice Address - Street 1:850 W HIGHLAND AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-3855
Practice Address - Country:US
Practice Address - Phone:909-886-7576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical