MEDICARE: RAISA HOWARD NP

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
1	363LW0102X	Women's Health Nurse Practitioner	6214	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN357727	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1235213901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAISA HOWARD NP

Provider Business Mailing Address
First Line	:	2284 E MAPLE AVE
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-6507
Country	:	US
Telephone Number	:	310-414-9761
Fax Number	:	310-414-9765

Provider Business Practice Location Address
First Line	:	2284 E MAPLE AVE
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-6507
Country	:	US
Telephone Number	:	310-414-9761
Fax Number	:	310-414-9765

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	10/20/2023

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