Provider Demographics
NPI:1174639074
Name:RAFIDI, FUAD F (MD)
Entity Type:Individual
Prefix:
First Name:FUAD
Middle Name:F
Last Name:RAFIDI
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 1:18226 VENTURA BOULEVARD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4246
Mailing Address - Country:US
Mailing Address - Phone:818-345-6126
Mailing Address - Fax:818-345-5061
Practice Address - Street 1:18226 VENTURA BOULEVARD
Practice Address - Street 2:SUITE 102
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4246
Practice Address - Country:US
Practice Address - Phone:818-345-6126
Practice Address - Fax:818-345-5061
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38061174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW2648Medicare ID - Type Unspecified
CATG088Medicare ID - Type Unspecified