Provider Demographics
NPI:1497895601
Name:ZIEGLER, RAPHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:
Last Name:ZIEGLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 S PACIFIC COAST HWY
Mailing Address - Street 2:STE 200
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3769
Mailing Address - Country:US
Mailing Address - Phone:310-855-3288
Mailing Address - Fax:310-855-3498
Practice Address - Street 1:1014 S PACIFIC COAST HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-4765
Practice Address - Country:US
Practice Address - Phone:310-855-3288
Practice Address - Fax:310-855-3498
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21258103G00000X, 103T00000X, 103TA0700X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497895601Medicare UPIN
CAC21258Medicare PIN