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Raphael Bonelle
NPI 1548613425 · on the registry since 2016 · sole proprietor
Practice
- Address
- 12000 N Virginia Ave
Oklahoma City, OK 73120 - Phone
- (405) 835-6757
- Organisation at this address
- Love Grow Live Center, Inc
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 5
Registry record
- Primary taxonomy
- 103K00000X
103K00000X
- Licence states on file
- OK
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2016-07-15
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Oklahoma