Healthcare Provider Details

I. General information

NPI: 1629066220
Provider Name (Legal Business Name): DAVOOD VAFAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2005
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40075 BOB HOPE DR SUITE A
RANCHO MIRAGE CA
92270-3942
US

IV. Provider business mailing address

40075 BOB HOPE DR SUITE A
RANCHO MIRAGE CA
92270-3942
US

V. Phone/Fax

Practice location:
  • Phone: 760-341-3688
  • Fax:
Mailing address:
  • Phone: 760-341-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA50294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: