1417306127 NPI number — VIRGINIA MARIA RAFFAELE PA-C, CD

Table of content: VIRGINIA MARIA RAFFAELE PA-C, CD (NPI 1417306127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417306127 NPI number — VIRGINIA MARIA RAFFAELE PA-C, CD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAFFAELE
Provider First Name:
VIRGINIA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C, CD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VERAZ
Provider Other First Name:
VIRGINIA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417306127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2930 MAPLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98201-3832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-261-1500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2930 MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201-3832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-261-1500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  60827984 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374J00000X , with the licence number: 14122 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)