Healthcare Provider Details

I. General information

NPI: 1629043054
Provider Name (Legal Business Name): RANA ROFAGHA SAJJADIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RANA ROFAGHA MD

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23781 MAQUINA AVE. SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
MISSION VIEJO CA
92691-2716
US

IV. Provider business mailing address

23781 MAQUINA AVE. SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
MISSION VIEJO CA
92691-2716
US

V. Phone/Fax

Practice location:
  • Phone: 412-965-7204
  • Fax:
Mailing address:
  • Phone: 412-965-7204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA-95792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: