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Organization
WELLCARE VALLEY MEDICAL GROUP INC
Active
Organization
WELLCARE VALLEY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAQUEL LACUESTA (CEO)
(747) 370-6986
Entity
Organization
Contact information
Practice address
10324 BALBOA BLVD STE 204, GRANADA HILLS, CA 91344-7349
(949) 324-8363
Mailing address
10324 BALBOA BLVD STE 225, GRANADA HILLS, CA 91344-7349
(747) 370-6986
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
03/10/2025
Last updated
11/17/2025
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