Provider Demographics
NPI:1437338647
Name:RAFAEL, JOURAK RICK (DPT, OCS, CSCS)
Entity Type:Individual
Prefix:DR
First Name:JOURAK
Middle Name:RICK
Last Name:RAFAEL
Suffix:
Gender:M
Credentials:DPT, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5608
Mailing Address - Country:US
Mailing Address - Phone:310-878-2540
Mailing Address - Fax:310-878-2536
Practice Address - Street 1:2010 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5608
Practice Address - Country:US
Practice Address - Phone:310-878-2540
Practice Address - Fax:310-878-2536
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEN655AMedicare PIN