Provider Demographics
NPI:1710392253
Name:ZOSPAH, RAELENE (MD)
Entity Type:Individual
Prefix:
First Name:RAELENE
Middle Name:
Last Name:ZOSPAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26900 WINCHESTER CREEK AVE APT 5304
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-4108
Mailing Address - Country:US
Mailing Address - Phone:505-274-9463
Mailing Address - Fax:
Practice Address - Street 1:222 N PACIFIC COAST HWY STE 1420
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-5648
Practice Address - Country:US
Practice Address - Phone:877-878-3289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA179133208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery