Healthcare Provider Details

I. General information

NPI: 1609330364
Provider Name (Legal Business Name): AFAF ASFOUR RCP-RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 ROSANA WAY
ROHNERT PARK CA
94928-2951
US

IV. Provider business mailing address

401 BICENTENNIAL WAY
SANTA ROSA CA
95403-2149
US

V. Phone/Fax

Practice location:
  • Phone: 707-328-4258
  • Fax:
Mailing address:
  • Phone: 707-867-7801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number28890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: