Provider Demographics
NPI:1073559241
Name:RAFIZAD, AMIR B (MD)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:B
Last Name:RAFIZAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54788
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-4788
Mailing Address - Country:US
Mailing Address - Phone:949-872-2400
Mailing Address - Fax:949-872-2401
Practice Address - Street 1:113 WATERWORKS WAY
Practice Address - Street 2:SUITE 345
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3167
Practice Address - Country:US
Practice Address - Phone:949-872-2400
Practice Address - Fax:949-872-2401
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81189207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA81189OtherSTATE LICENSE
CAW18108Medicare ID - Type Unspecified
CADO958ZMedicare PIN
CAI20085Medicare UPIN