Provider Demographics
NPI:1073918769
Name:ASIF RAFI MD INC
Entity Type:Organization
Organization Name:ASIF RAFI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASIF
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-256-2984
Mailing Address - Street 1:11500 W. OLYMPIC BLVD
Mailing Address - Street 2:SUITE 626
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1530
Mailing Address - Country:US
Mailing Address - Phone:424-256-2984
Mailing Address - Fax:424-273-1781
Practice Address - Street 1:11500 W. OLYMPIC BLVD
Practice Address - Street 2:SUITE 626
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1530
Practice Address - Country:US
Practice Address - Phone:424-256-2984
Practice Address - Fax:424-273-1781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78785174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH33018Medicare UPIN
CAWA78785CMedicare PIN