Healthcare Provider Details

I. General information

NPI: 1417718081
Provider Name (Legal Business Name): J. MOUCHARRAFIE, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1781 W ROMNEYA DR STE E
ANAHEIM CA
92801-1818
US

IV. Provider business mailing address

1781 W ROMNEYA DR STE E
ANAHEIM CA
92801-1818
US

V. Phone/Fax

Practice location:
  • Phone: 714-774-0414
  • Fax: 714-774-0494
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMILA MOUCHARRAFIE
Title or Position: PRESIDENT
Credential: MD
Phone: 714-774-0414