Healthcare Provider Details

I. General information

NPI: 1982595658
Provider Name (Legal Business Name): DANIEL RAPHA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21751 SW 98TH AVE
CUTLER BAY FL
33190-1182
US

IV. Provider business mailing address

18495 S DIXIE HWY PMB 367
CUTLER BAY FL
33157-6817
US

V. Phone/Fax

Practice location:
  • Phone: 785-530-6991
  • Fax:
Mailing address:
  • Phone: 785-530-6991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL R SANTIAGO
Title or Position: LICENSED COUNSELOR MANAGER
Credential:
Phone: 305-879-3948