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General NPI Number Information
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NPI Number | 1467847152
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Entity Type | Organization
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Legal Business Name | RAPHA FAMILY CLINIC INC
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 03/31/2015
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Provider Practice Location Address
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Address Line | 9778 FOREST LN
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City | DALLAS
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State | TX
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Zip | 75243-5702
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Country | US
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Telephone | 469-826-9812
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Fax | 972-442-3348
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Provider Business Mailing Address
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Address Line | 9778 FOREST LN
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City | DALLAS
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State | TX
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Zip | 75243-5702
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Country | US
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Telephone | 469-826-9812
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Fax | 972-442-3348
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Authorized Official
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Title or Position | OWNER
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Name | MARTINA DIKE
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Credential | AP
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Telephone | 469-826-9812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | AP124298
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License Number State | TX
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