Provider Demographics
NPI:1790439586
Name:MUSSEB-GIL, RAFAEL (FL-MH19985/CA-18667)
Entity type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:
Last Name:MUSSEB-GIL
Suffix:
Gender:
Credentials:FL-MH19985/CA-18667
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 SHORELINE DR APT 309
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6214
Mailing Address - Country:US
Mailing Address - Phone:321-278-1928
Mailing Address - Fax:
Practice Address - Street 1:344 20TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3577
Practice Address - Country:US
Practice Address - Phone:321-278-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18667101Y00000X, 101YP2500X, 101YM0800X
FLMH19985101YM0800X, 101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional