Provider Demographics
NPI:1083789085
Name:MATTAR, RAAFAT N (MD)
Entity Type:Individual
Prefix:DR
First Name:RAAFAT
Middle Name:N
Last Name:MATTAR
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 1:5267 WARNER AVE
Mailing Address - Street 2:#175
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4079
Mailing Address - Country:US
Mailing Address - Phone:714-521-9703
Mailing Address - Fax:714-312-5864
Practice Address - Street 1:5199 E PACIFIC COAST HWY STE 304
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3355
Practice Address - Country:US
Practice Address - Phone:562-493-2225
Practice Address - Fax:562-426-8929
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82852207L00000X, 208VP0014X, 207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A828520Medicaid
CA00A828520Medicaid