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General NPI Number Information
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NPI Number | 1568278679
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Entity Type | Individual
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Provider Name | RAFAEL URIBE
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Gender | Male
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 10351 SANTA MONICA BLVD STE 101
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City | LOS ANGELES
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State | CA
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Zip | 90025-6943
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Country | US
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Telephone | 310-286-0447
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 PEG PL APT 105
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City | LOS ANGELES
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State | CA
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Zip | 90035-2827
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Country | US
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Telephone | 773-416-9587
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 307342
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License Number State | CA
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