Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 22130 | CA |
NPI | 1023442118 |
---|---|
Provider Name | Dr. Mohammad Rafifar |
First Address | Redondo Beach, CA 90277-5511 |
Second Address | Redondo Beach, CA 90277-5511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2013 |
Last Update Date | 09/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC22130 | CHIROPRACTIC (01) | CA |