Healthcare Provider Details

I. General information

NPI: 1972735173
Provider Name (Legal Business Name): RAFIK WILLIAM PHILOBOS L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 S MAIN ST STE 101B&103
CORONA CA
92882-5303
US

IV. Provider business mailing address

2275 S MAIN ST SUITE 201
CORONA CA
92882-5303
US

V. Phone/Fax

Practice location:
  • Phone: 951-279-3222
  • Fax: 951-279-5222
Mailing address:
  • Phone: 951-279-3222
  • Fax: 951-279-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: