MEDICARE: ARDAVAN JOHN RAFIZADEH PA-C

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	363A00000X	Physician Assistant	62479	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174564058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARDAVAN JOHN RAFIZADEH PA-C

Provider Business Mailing Address
First Line	:	100 WILSON RD STE 100
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-7885
Country	:	US
Telephone Number	:	831-649-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 SAN JOSE ST STE 301
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93901-3928
Country	:	US
Telephone Number	:	831-759-3289
Fax Number	:	831-758-1565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	06/29/2023

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