Provider Demographics
NPI:1073265252
Name:DEFRAWY AND ASSOCIATES
Entity Type:Organization
Organization Name:DEFRAWY AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPANY PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DEFRAWY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-668-7420
Mailing Address - Street 1:86 PAINTED TRELLIS
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-2306
Mailing Address - Country:US
Mailing Address - Phone:949-668-7420
Mailing Address - Fax:
Practice Address - Street 1:16121 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3804
Practice Address - Country:US
Practice Address - Phone:949-668-7420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service