Healthcare Provider Details

I. General information

NPI: 1033625074
Provider Name (Legal Business Name): MENA RAAFAT ZAKI ROFAEIL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 FELICE DR
HOLLISTER CA
95023-3361
US

IV. Provider business mailing address

3641 CLAYTON RD APT 15
CONCORD CA
94521-2579
US

V. Phone/Fax

Practice location:
  • Phone: 831-637-5306
  • Fax:
Mailing address:
  • Phone: 424-303-0707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number102221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: