Healthcare Provider Details

I. General information

NPI: 1205432291
Provider Name (Legal Business Name): J RAPHA MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 S BUDLONG AVE
LOS ANGELES CA
90037-2811
US

IV. Provider business mailing address

4601 S BUDLONG AVE
LOS ANGELES CA
90037-2811
US

V. Phone/Fax

Practice location:
  • Phone: 310-844-3440
  • Fax: 725-209-1284
Mailing address:
  • Phone: 832-368-9832
  • Fax: 725-209-1284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. REGINA WIGGINS SPEIGHTS
Title or Position: CEO
Credential: DNP, FNP-C, PMHNP-BC
Phone: 310-844-3440