MEDICARE: REFAEL MEDICAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1003502386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REFAEL MEDICAL, INC.

Provider Business Mailing Address
First Line	:	8200 WILSHIRE BLVD
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2328
Country	:	US
Telephone Number	:	310-879-7167
Fax Number	:	713-510-1548

Provider Business Practice Location Address
First Line	:	8200 WILSHIRE BLVD
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2328
Country	:	US
Telephone Number	:	310-879-7167
Fax Number	:	310-933-5688

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL FARAH
Credential	:
Telephone Number	:	310-879-7167

Provider Enumeration Date	:	04/11/2023
Last Update Date	:	08/09/2023

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