Individual provider Active NPI

Rachel Clare Caudillo, LCSW

  • Clinical Social Worker
  • Rialto, CA
National Provider Identifier
1659418283
Registry record updated Aug 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCS28672 Issued in CA
Practice address
850 E Foothill Blvd
Rialto, CA 92376-5230
Phone
(909) 421-9470
NPI assigned
Jan 31, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCS28672 CA Primary

Addresses

Primary practice location

850 E Foothill Blvd
Rialto, CA 92376-5230

Mailing address

850 E Foothill Blvd
Rialto, CA 92376-5230
Phone (909) 421-9470

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160219000601 CA Practitioner - Clinical Social Worker 9436454055 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Foothills Psychological Services IncGroup PAC ID 9436157534, 37 clinicians

Practice addresses (Care Compare)

954 W Foothill Blvd
Suite a
Upland, CA 91786-3782
Phone (909) 946-4222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCS28672CAMDClinical Social Worker
28672CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Mission City Community Network, Inc. Current Accepting new patients
Mission City Community Network, Inc. CurrentSince Feb 21, 2024 Accepting new patients
Mission City Community Network, Inc. CurrentSince Feb 21, 2024 Accepting new patients

Locations

8363 Reseda Blvd
Ste 11
Northridge, CA 91324
Phone 8188953100602

15206 Parthenia St
Sepulveda, CA 91343

15201 Eleventh St
Ste 300
Victorville, CA 92395
Phone (760) 245-1640

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343865600000",
    "number": "1659418283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 E FOOTHILL BLVD",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923765230",
            "telephone_number": "909-421-9470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 E FOOTHILL BLVD",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923765230",
            "telephone_number": "909-421-9470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAUDILLO",
        "first_name": "RACHEL",
        "middle_name": "CLARE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2012-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS28672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rialto, CA

Sources for this page

Verify at the official NPI Registry.