Provider Demographics
NPI:1801883038
Name:RAPHAEL, CARMEL NICHOLE (PA)
Entity type:Individual
Prefix:MS
First Name:CARMEL
Middle Name:NICHOLE
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:4314 W SLAUSON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-2808
Mailing Address - Country:US
Mailing Address - Phone:323-293-7171
Mailing Address - Fax:310-348-3716
Practice Address - Street 1:4314 W SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-2808
Practice Address - Country:US
Practice Address - Phone:323-293-7171
Practice Address - Fax:310-348-3716
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA14798363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant