Healthcare Provider Details

I. General information

NPI: 1053626630
Provider Name (Legal Business Name): RAAFAT W. GIRGIS, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2010
Last Update Date: 08/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20072 SW BIRCH ST SUITE # 240
NEWPORT BEACH CA
92660-0794
US

IV. Provider business mailing address

20072 SW BIRCH ST SUITE # 240
NEWPORT BEACH CA
92660-0794
US

V. Phone/Fax

Practice location:
  • Phone: 714-316-1163
  • Fax: 714-882-7765
Mailing address:
  • Phone: 714-316-1163
  • Fax: 714-882-7765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberA52207
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberA52207
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberA52207
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberA52207
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberA52207
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA52207
License Number StateCA

VIII. Authorized Official

Name: DR. RAAFAT W GIRGIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-316-1163