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General NPI Number Information
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NPI Number | 1205432291
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Entity Type | Organization
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Legal Business Name | J RAPHA MANAGEMENT
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Dates
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Enumeration Date | 12/07/2020
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 4601 S BUDLONG AVE
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City | LOS ANGELES
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State | CA
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Zip | 90037-2811
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Country | US
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Telephone | 310-844-3440
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Fax | 725-209-1284
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Provider Business Mailing Address
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Address Line | 4601 S BUDLONG AVE
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City | LOS ANGELES
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State | CA
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Zip | 90037-2811
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Country | US
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Telephone | 832-368-9832
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Fax | 725-209-1284
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Authorized Official
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Title or Position | CEO
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Name | DR. REGINA WIGGINS SPEIGHTS
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Credential | DNP, FNP-C, PMHNP-BC
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Telephone | 310-844-3440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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