Healthcare Provider Details

I. General information

NPI: 1174268585
Provider Name (Legal Business Name): ABRAHAM SHERIF ALFARRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S DOBSON RD
MESA AZ
85202-4707
US

IV. Provider business mailing address

1400 S DOBSON RD
MESA AZ
85202-4707
US

V. Phone/Fax

Practice location:
  • Phone: 480-684-6684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number79613
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: