Basic Information
| Provider Information | |||||||||
| NPI: | 1356607022 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OKUBO | ||||||||
| FirstName: | RAQUEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 S MESA HILLS DR | ||||||||
| Address2: | SUITE C3 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799125757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155321587 | ||||||||
| FaxNumber: | 9155449955 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 S MESA HILLS DR | ||||||||
| Address2: | SUITE C3 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799125757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155321587 | ||||||||
| FaxNumber: | 9155449955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2012 | ||||||||
| LastUpdateDate: | 04/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 608497 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.