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General NPI Number Information
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NPI Number | 1346124120
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Entity Type | Organization
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Legal Business Name | RAPHAEL DIRECT PRIMARY CARE PLLC
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 4722 EVERHART RD
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-2740
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Country | US
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Telephone | 512-296-3747
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Fax |
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Provider Business Mailing Address
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Address Line | 4722 EVERHART RD
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-2740
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Country | US
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Telephone | 361-304-8007
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Fax | 361-201-8911
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Authorized Official
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Title or Position | MANAGER
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Name | DR. AVEGIYEL DUNN
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Credential | DO
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Telephone | 361-304-8007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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