Provider Demographics
NPI:1720224603
Name:RAFFEL, JENNIFER MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:RAFFEL
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 1:8021 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5619
Mailing Address - Country:US
Mailing Address - Phone:602-380-4041
Mailing Address - Fax:
Practice Address - Street 1:15612 N 32ND ST
Practice Address - Street 2:STE. #3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3859
Practice Address - Country:US
Practice Address - Phone:602-251-8052
Practice Address - Fax:602-251-8068
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87652207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ41502OtherARIZONA MEDICAL BOARD
CAA87652OtherMEDICAL BOARD OF CALIFORNIA