Provider Demographics
NPI:1164034625
Name:RAFFO, MINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:
Last Name:RAFFO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 PERSIMMON AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4872
Mailing Address - Country:US
Mailing Address - Phone:619-456-8973
Mailing Address - Fax:
Practice Address - Street 1:1185 PERSIMMON AVE APT 7
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4872
Practice Address - Country:US
Practice Address - Phone:619-456-8973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1053181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice