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General NPI Number Information
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NPI Number | 1619993326
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Entity Type | Individual
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Provider Name | RAPHAEL I GUNNER PSY.D
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2001 S BARRINGTON AVE STE 202
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City | LOS ANGELES
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State | CA
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Zip | 90025-5385
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Country | US
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Telephone | 310-570-1919
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Fax | 310-914-9124
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Provider Business Mailing Address
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Address Line | 1644 COLBY AVE APT 6
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City | LOS ANGELES
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State | CA
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Zip | 90025-3051
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Country | US
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Telephone | 310-583-8552
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Fax | 310-941-9124
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY19173
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License Number State | CA
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