Healthcare Provider Details

I. General information

NPI: 1730243676
Provider Name (Legal Business Name): JENNY RAPHAEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 02/28/2026
Certification Date: 02/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 PEAR TREE LN
NAPA CA
94558-6484
US

IV. Provider business mailing address

1141 PEAR TREE LN
NAPA CA
94558-6484
US

V. Phone/Fax

Practice location:
  • Phone: 707-254-1770
  • Fax:
Mailing address:
  • Phone: 707-254-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number242189
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA76422
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD073232L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: