| Doctor Name: | BRIAN A RAQUENO |
| NPI Number: | 1548562523 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT, DPT |
| License Number: | J1-0002540 |
| Business Practice Address: | 9850 19th St Apt 186 Alta Loma, CA - 917374232 |
| Business Phone Number: | 3023452863 |
| Business Fax Number: | |
| Mailing Address: | 9850 19th St, Apt 186 ALTA LOMA |
| State: | CA |
| Postal Code: | 917374232 |
| Phone Number: | 3023452863 |
| Fax Number: | |
| NPI Enumeration Date: | 11/24/2010 |
| NPI Last Update Date: | 01/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | J1-0002540 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | DE |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |