Provider Demographics
NPI:1417915448
Name:RAFAEL, ANDRE (LAC, PHD)
Entity Type:Individual
Prefix:PROF
First Name:ANDRE
Middle Name:
Last Name:RAFAEL
Suffix:
Gender:M
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 S LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3325
Mailing Address - Country:US
Mailing Address - Phone:310-659-2888
Mailing Address - Fax:310-659-2899
Practice Address - Street 1:291 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3325
Practice Address - Country:US
Practice Address - Phone:310-659-2888
Practice Address - Fax:310-659-2899
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 6448171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist