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NPI Code Detail

MEDICARE: RAFAELA RASLAN SOUZA

MEDICARE: RAFAELA RASLAN SOUZA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1013712124
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAFAELA RASLAN SOUZA
Provider Business Mailing Address
First Line : 2501 PICO BLVD APT 329
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-1846
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 613 OCEAN PARK BLVD
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-3713
Country : US
Telephone Number : 206-841-6561
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2025
Last Update Date : 02/14/2025

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Directions to “ RAFAELA RASLAN SOUZA ” Practice Location

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