MEDICARE: MS. CARMEL NICHOLE RAPHAEL PA

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	363A00000X	Physician Assistant	14798	CA

General Provider Information

NPI Number	:	1801883038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARMEL NICHOLE RAPHAEL PA

Provider Business Mailing Address
First Line	:	4314 W SLAUSON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-2808
Country	:	US
Telephone Number	:	323-293-7171
Fax Number	:	310-348-3716

Provider Business Practice Location Address
First Line	:	4314 W SLAUSON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-2808
Country	:	US
Telephone Number	:	323-293-7171
Fax Number	:	310-348-3716

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	06/01/2021

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