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NPI Code Detail

MEDICARE: CLONGE WAYNE RAFUS

MEDICARE: CLONGE WAYNE RAFUS
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
1174400000XSpecialist
2175T00000XPeer Specialist

General Provider Information

NPI Number : 1851717318
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLONGE WAYNE RAFUS
Provider Business Mailing Address
First Line : 2342 SHATTUCK AVE APT 112
Second Line :
City : BERKELEY
State : CA
Zip : 94704-1517
Country : US
Telephone Number : 510-735-3004
Fax Number :
Provider Business Practice Location Address
First Line : 7200 BANCROFT AVE STE 267
Second Line :
City : OAKLAND
State : CA
Zip : 94605-2408
Country : US
Telephone Number : 510-735-0864
Fax Number : 510-647-9408
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2014
Last Update Date : 01/27/2025

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Directions to “ CLONGE WAYNE RAFUS ” Practice Location

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