Healthcare Provider Details

I. General information

NPI: 1154524429
Provider Name (Legal Business Name): RAAFAT S ROKES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 IMPERIAL HWY
DOWNEY CA
90242-3456
US

IV. Provider business mailing address

560 GLENWOOD RD APT 302
GLENDALE CA
91202-1503
US

V. Phone/Fax

Practice location:
  • Phone: 562-401-6232
  • Fax:
Mailing address:
  • Phone: 818-291-0468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: