Healthcare Provider Details

I. General information

NPI: 1952463564
Provider Name (Legal Business Name): RAIF WADIE ISKANDER PA-C, D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 WARNER AVE SUITE D
TUSTIN CA
92780-6444
US

IV. Provider business mailing address

1431 WARNER AVE SUITE D
TUSTIN CA
92780-6444
US

V. Phone/Fax

Practice location:
  • Phone: 949-734-4335
  • Fax: 949-264-1083
Mailing address:
  • Phone: 949-734-4335
  • Fax: 949-264-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21793
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number23282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: