Healthcare Provider Details

I. General information

NPI: 1588587513
Provider Name (Legal Business Name): RAPHAEL BIASSOU HERISSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LEGACIA BRANDING CAPITAL

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 VAN BUREN ST NW
WASHINGTON DC
20012-2835
US

IV. Provider business mailing address

1513 VAN BUREN ST NW 1513 VAN BUREN ST NW
WASHINGTON DC
20012-2835
US

V. Phone/Fax

Practice location:
  • Phone: 202-275-3025
  • Fax:
Mailing address:
  • Phone: 202-275-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: