1902362973 NPI number — AMANDA RAFI, DMD APDC

Table of content: TRISHA KAY COOK RN (NPI 1972069938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902362973 NPI number — AMANDA RAFI, DMD APDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMANDA RAFI, DMD APDC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902362973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14591 NEWPORT AVE STE 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSTIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92780-6026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14591 NEWPORT AVE STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSTIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92780-6026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-771-7234
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2019

Additional Information

Authorized Official

Authorized Official Last Name:
RAFI
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
480-510-8888

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1598268849 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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