Provider Demographics
NPI:1548914088
Name:JOSON, RAPHAEL BERNARDO (PT)
Entity type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:BERNARDO
Last Name:JOSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 DEL VALLE CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6233
Mailing Address - Country:US
Mailing Address - Phone:925-918-3677
Mailing Address - Fax:
Practice Address - Street 1:249 DEL VALLE CT
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6233
Practice Address - Country:US
Practice Address - Phone:925-918-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28729208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation