Healthcare Provider Details

I. General information

NPI: 1235213901
Provider Name (Legal Business Name): RAISA HOWARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2284 E MAPLE AVE
EL SEGUNDO CA
90245-6507
US

IV. Provider business mailing address

2284 E MAPLE AVE
EL SEGUNDO CA
90245-6507
US

V. Phone/Fax

Practice location:
  • Phone: 310-414-9761
  • Fax: 310-414-9765
Mailing address:
  • Phone: 310-414-9761
  • Fax: 310-414-9765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number357727
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number357727
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number6214
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number357727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: