Provider Demographics
NPI:1306220587
Name:HUMMEL, RAYMOND (NP)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:HUMMEL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N KINGS RD APT 318
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-5909
Mailing Address - Country:US
Mailing Address - Phone:323-336-2166
Mailing Address - Fax:
Practice Address - Street 1:750 N KINGS RD APT 318
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-5909
Practice Address - Country:US
Practice Address - Phone:323-336-2166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002758363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care