Provider Demographics
NPI:1144417866
Name:PAUL K. RAFFER,M.D., INC.
Entity Type:Organization
Organization Name:PAUL K. RAFFER,M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUGHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-421-6741
Mailing Address - Street 1:750 MEDICAL CENTER CT
Mailing Address - Street 2:STE.13
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6634
Mailing Address - Country:US
Mailing Address - Phone:619-421-6741
Mailing Address - Fax:
Practice Address - Street 1:750 MEDICAL CENTER CT
Practice Address - Street 2:STE.13
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6634
Practice Address - Country:US
Practice Address - Phone:619-421-6741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG2501602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY19682Medicare UPIN