Healthcare Provider Details

I. General information

NPI: 1992255202
Provider Name (Legal Business Name): RAFAELA DESOUZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 WAVERLY ST
FRAMINGHAM MA
01702-7079
US

IV. Provider business mailing address

650 LINCOLN ST
WORCESTER MA
01605-2060
US

V. Phone/Fax

Practice location:
  • Phone: 508-370-0113
  • Fax: 508-270-5700
Mailing address:
  • Phone: 508-370-0113
  • Fax: 508-270-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2311146
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: