Individual
MR. RAPHAEL OMOTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
2215 E LAKE ST, MINNEAPOLIS, MN 55407-4385
(612) 596-9438
Mailing address
7420 UNITY AVE N STE 310C, BROOKLYN PARK, MN 55443-3162
(612) 212-2595
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
9968
MN
Other
Enumeration date
02/27/2023
Last updated
04/02/2026
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