Healthcare Provider Details

I. General information

NPI: 1396049235
Provider Name (Legal Business Name): PARVANEH RAFAELOFF, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 S. GLENDALE AVE #308
GLENDALE CA
91205-2866
US

IV. Provider business mailing address

1030 S. GLENDALE AVE #308
GLENDALE CA
91205-2866
US

V. Phone/Fax

Practice location:
  • Phone: 818-265-1255
  • Fax: 818-265-1283
Mailing address:
  • Phone: 818-265-1255
  • Fax: 818-265-1283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA52350
License Number StateCA

VIII. Authorized Official

Name: MRS. PARVANEH RAFAELOFF
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 818-265-1255