Healthcare Provider Details

I. General information

NPI: 1639655855
Provider Name (Legal Business Name): RAPHAELLA ROSE CHIARAMONTE LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 GRAND VIEW BLVD
LOS ANGELES CA
90066-4405
US

IV. Provider business mailing address

509 PACIFIC ST APT 207
SANTA MONICA CA
90405-2478
US

V. Phone/Fax

Practice location:
  • Phone: 646-217-9074
  • Fax:
Mailing address:
  • Phone: 646-217-9074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: