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General NPI Number Information
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NPI Number | 1932611225
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Entity Type | Individual
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Provider Name | RENEE RAFFALOVICH PYBURN PMHNP
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Gender | Female
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 01/31/2020
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Provider Practice Location Address
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Address Line | 202 N 8TH ST
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City | EL CENTRO
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State | CA
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Zip | 92243-2302
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Country | US
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Telephone | 512-809-2286
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Fax |
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Provider Business Mailing Address
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Address Line | 1936 ANTONE ST
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City | AUSTIN
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State | TX
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Zip | 78723-5443
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Country | US
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Telephone | 512-809-2286
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95010655
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP136440
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP60923286
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F402345
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License Number State | NY
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