Basic Information
| Provider Information | |||||||||
| NPI: | 1376780676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAFANAN | ||||||||
| FirstName: | EMILIA | ||||||||
| MiddleName: | ROSARIO | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8367 WHITMORE ST | ||||||||
| Address2: | |||||||||
| City: | ROSEMEAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917702648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268644621 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 W 1ST ST | ||||||||
| Address2: | 6TH FLOOR | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900124112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2139961343 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2009 | ||||||||
| LastUpdateDate: | 03/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 655789 | CA | N | Nursing Service Providers | Registered Nurse | 163WP0808X | 655789 | CA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.