Healthcare Provider Details

I. General information

NPI: 1609610104
Provider Name (Legal Business Name): MARK HAFT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26520 CACTUS AVE
MORENO VALLEY CA
92555-3927
US

IV. Provider business mailing address

26520 CACTUS AVE
MORENO VALLEY CA
92555-3927
US

V. Phone/Fax

Practice location:
  • Phone: 951-486-4698
  • Fax:
Mailing address:
  • Phone: 951-486-4698
  • Fax: 951-486-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20A25397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: