Healthcare Provider Details

I. General information

NPI: 1225080013
Provider Name (Legal Business Name): RAAFAT W GIRGIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 DOVE ST SUITE # 145
NEWPORT BEACH CA
92660-3023
US

IV. Provider business mailing address

901 DOVE ST SUITE # 145
NEWPORT BEACH CA
92660-3023
US

V. Phone/Fax

Practice location:
  • Phone: 949-955-1088
  • Fax: 949-955-1098
Mailing address:
  • Phone: 949-955-1088
  • Fax: 949-955-1098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: