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General NPI Number Information
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NPI Number | 1962704106
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Entity Type | Organization
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Legal Business Name | IBTESAM RAFAEE MD INC
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Dates
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Enumeration Date | 11/19/2010
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Last Update Date | 11/19/2010
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Provider Practice Location Address
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Address Line | 710 S BROOKHURST ST SUITE A
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City | ANAHEIM
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State | CA
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Zip | 92804-4321
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Country | US
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Telephone | 714-533-2922
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Fax | 714-533-2902
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Provider Business Mailing Address
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Address Line | 852 SAINT JAMES DR
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City | CORONA
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State | CA
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Zip | 92882-6881
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Country | US
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Telephone | 714-533-2922
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Fax | 714-533-2902
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Authorized Official
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Title or Position | PRESIDENT
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Name | IBTESAM RAFAEE
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Credential | MD
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Telephone | 714-533-2922
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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 |
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License Number State |
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