Healthcare Provider Details

I. General information

NPI: 1184695371
Provider Name (Legal Business Name): VAFA MATIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 N CENTRAL AVE BLDG C
PHOENIX AZ
85012-3313
US

IV. Provider business mailing address

4041 N CENTRAL AVE BLDG C
PHOENIX AZ
85012-3313
US

V. Phone/Fax

Practice location:
  • Phone: 602-279-5262
  • Fax:
Mailing address:
  • Phone: 602-279-5262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number3833
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3833
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: