Provider Demographics
NPI:1417537721
Name:RAFFEL, LILLIAN LEAVITT (RN)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:LEAVITT
Last Name:RAFFEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N ROXBURY DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3240
Mailing Address - Country:US
Mailing Address - Phone:310-276-5710
Mailing Address - Fax:310-276-5093
Practice Address - Street 1:601 N ROXBURY DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-3240
Practice Address - Country:US
Practice Address - Phone:310-276-5710
Practice Address - Fax:310-276-5093
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-11
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246380163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice