Healthcare Provider Details

I. General information

NPI: 1588731467
Provider Name (Legal Business Name): RAFFY MIRZAYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 FOOTHILL BLVD STE 121
LA CANADA CA
91011-3518
US

IV. Provider business mailing address

466 FOOTHILL BLVD STE 121
LA CANADA CA
91011-3518
US

V. Phone/Fax

Practice location:
  • Phone: 424-235-7187
  • Fax:
Mailing address:
  • Phone: 424-235-7187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA60906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: