Provider Demographics
NPI:1164249611
Name:CLIPPINGER, RAQUEL MARIE
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:MARIE
Last Name:CLIPPINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8881 FLETCHER PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3187
Mailing Address - Country:US
Mailing Address - Phone:619-464-6434
Mailing Address - Fax:619-464-5109
Practice Address - Street 1:8881 FLETCHER PKWY STE 205
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3187
Practice Address - Country:US
Practice Address - Phone:619-464-6434
Practice Address - Fax:619-464-5109
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032282363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics