=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144417866
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAUL K. RAFFER,M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2007
-----------------------------------------------------
Last Update Date | 09/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 MEDICAL CENTER CT STE.13
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91911-6634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-421-6741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 750 MEDICAL CENTER CT STE.13
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91911-6634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-421-6741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | SARA LOUGHRAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 619-421-6741
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | G250160
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------