MEDICARE: NIUSHA RAFIE MD

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	174400000X	Specialist	A96782	AL
2	2085R0202X	Diagnostic Radiology Physician	A96782	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	:	1396844395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIUSHA RAFIE MD

Provider Business Mailing Address
First Line	:	PO BOX 1764
Second Line	:
City	:	LODI
State	:	CA
Zip	:	95241-1764
Country	:	US
Telephone Number	:	415-677-2325
Fax Number	:	415-677-2444

Provider Business Practice Location Address
First Line	:	845 JACKSON STREET
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94133-4851
Country	:	US
Telephone Number	:	415-677-2325
Fax Number	:	415-677-2444

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	03/06/2008

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Directions to “ NIUSHA RAFIE MD” Practice Location

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