Provider Demographics
NPI:1538557855
Name:RAPHAEL, KIZZY (ND)
Entity type:Individual
Prefix:DR
First Name:KIZZY
Middle Name:
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:KIZZY
Other - Middle Name:
Other - Last Name:SCHALKWIJK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:1601 EL CAMINO REAL
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3948
Mailing Address - Country:US
Mailing Address - Phone:650-503-3759
Mailing Address - Fax:650-243-4430
Practice Address - Street 1:1601 EL CAMINO REAL
Practice Address - Street 2:SUITE 303
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3948
Practice Address - Country:US
Practice Address - Phone:650-503-3759
Practice Address - Fax:650-243-4430
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND682175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath