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General NPI Number Information
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NPI Number | 1588783690
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Entity Type | Individual
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Provider Name | DR. REZA RAFIE
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 27192 NEWPORT RD STE 2
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City | MENIFEE
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State | CA
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Zip | 92584-7387
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Country | US
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Telephone | 951-672-9457
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Fax |
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Provider Business Mailing Address
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Address Line | 2883 RUE MONTREUX
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City | ESCONDIDO
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State | CA
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Zip | 92026-8724
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Country | US
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Telephone | 858-342-5164
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 52463
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License Number State | CA
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