Healthcare Provider Details

I. General information

NPI: 1184077307
Provider Name (Legal Business Name): FRANK E RAFAIL DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11738 CARMEL MOUNTAIN RD STE 170
SAN DIEGO CA
92128-4635
US

IV. Provider business mailing address

11738 CARMEL MOUNTAIN RD STE 170
SAN DIEGO CA
92128-4635
US

V. Phone/Fax

Practice location:
  • Phone: 858-675-1180
  • Fax:
Mailing address:
  • Phone: 858-675-1180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number37483
License Number StateCA

VIII. Authorized Official

Name: FRANK E RAFAIL
Title or Position: OWNER
Credential: DMD
Phone: 858-675-1180