Healthcare Provider Details

I. General information

NPI: 1679238711
Provider Name (Legal Business Name): SEBASTIAN JAHANSHAH RAAFAT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 DORE ST
SAN FRANCISCO CA
94103-3828
US

IV. Provider business mailing address

368 FELL ST
SAN FRANCISCO CA
94102-5144
US

V. Phone/Fax

Practice location:
  • Phone: 415-861-0828
  • Fax: 415-861-0140
Mailing address:
  • Phone: 415-861-0828
  • Fax: 415-861-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60337
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: