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General NPI Number Information
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NPI Number | 1396049235
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Entity Type | Organization
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Legal Business Name | PARVANEH RAFAELOFF, MD, INC.
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Dates
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Enumeration Date | 01/07/2011
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 1030 S. GLENDALE AVE #308
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City | GLENDALE
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State | CA
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Zip | 91205-2866
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Country | US
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Telephone | 818-265-1255
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Fax | 818-265-1283
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Provider Business Mailing Address
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Address Line | 1030 S. GLENDALE AVE #308
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City | GLENDALE
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State | CA
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Zip | 91205-2866
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Country | US
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Telephone | 818-265-1255
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Fax | 818-265-1283
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | MRS. PARVANEH RAFAELOFF
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Credential | M.D.
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Telephone | 818-265-1255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A52350
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License Number State | CA
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