Provider Demographics
NPI:1639655855
Name:CHIARAMONTE, RAPHAELLA ROSE (LAC)
Entity type:Individual
Prefix:
First Name:RAPHAELLA
Middle Name:ROSE
Last Name:CHIARAMONTE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:509 PACIFIC ST APT 207
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2478
Mailing Address - Country:US
Mailing Address - Phone:646-217-9074
Mailing Address - Fax:
Practice Address - Street 1:3807 GRAND VIEW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-4405
Practice Address - Country:US
Practice Address - Phone:646-217-9074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18024171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist