Healthcare Provider Details

I. General information

NPI: 1174309520
Provider Name (Legal Business Name): RAPHAEL MORDECAI MIZRAHI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

IV. Provider business mailing address

11235 OAK LEAF DR APT B613
SILVER SPRING MD
20901-1318
US

V. Phone/Fax

Practice location:
  • Phone: 202-539-1225
  • Fax:
Mailing address:
  • Phone: 732-261-8711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: