Provider Demographics
NPI:1871843375
Name:AUSTIN, RACIELA B (NP)
Entity type:Individual
Prefix:
First Name:RACIELA
Middle Name:B
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3355 MICHELSON DR STE 490
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-0685
Mailing Address - Country:US
Mailing Address - Phone:949-672-9900
Mailing Address - Fax:949-526-8385
Practice Address - Street 1:3355 MICHELSON DR STE 490
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612
Practice Address - Country:US
Practice Address - Phone:949-672-9900
Practice Address - Fax:949-526-8385
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2019-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA587759163W00000X
CA21958363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse