Provider Demographics
NPI:1235213901
Name:HOWARD, RAISA (NP)
Entity Type:Individual
Prefix:
First Name:RAISA
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2284 E MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-6507
Mailing Address - Country:US
Mailing Address - Phone:310-414-9761
Mailing Address - Fax:310-414-9765
Practice Address - Street 1:2284 E MAPLE AVE
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-6507
Practice Address - Country:US
Practice Address - Phone:310-414-9761
Practice Address - Fax:310-414-9765
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6214363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN357727OtherMEDI-CAL