Healthcare Provider Details

I. General information

NPI: 1790287050
Provider Name (Legal Business Name): RAWAN GHARFEH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

956 S REGATTA DR
VALLEJO CA
94591-6946
US

V. Phone/Fax

Practice location:
  • Phone: 415-473-6666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95087202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: