Healthcare Provider Details

I. General information

NPI: 1407980410
Provider Name (Legal Business Name): MOHAMMAD RAFFAT KH JABER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8043 2ND ST STE 105
DOWNEY CA
90241-3692
US

IV. Provider business mailing address

8043 2ND ST STE 105
DOWNEY CA
90241-3692
US

V. Phone/Fax

Practice location:
  • Phone: 562-862-1134
  • Fax: 562-861-9895
Mailing address:
  • Phone: 562-862-1134
  • Fax: 423-408-7405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number50884
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA91996
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA91996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: