Healthcare Provider Details

I. General information

NPI: 1710683669
Provider Name (Legal Business Name): MAHRUKH RAFIQ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3095 TELEGRAPH AVE
BERKELEY CA
94705-2035
US

IV. Provider business mailing address

9639 ELMVIEW DR
OAKLAND CA
94603-1957
US

V. Phone/Fax

Practice location:
  • Phone: 510-495-0772
  • Fax:
Mailing address:
  • Phone: 954-812-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA9117046
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: