Provider Demographics
NPI:1184633976
Name:RAFAH, HAZRAT G (PA)
Entity Type:Individual
Prefix:
First Name:HAZRAT
Middle Name:G
Last Name:RAFAH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 GLENBRIAR CIR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-4144
Mailing Address - Country:US
Mailing Address - Phone:661-917-8500
Mailing Address - Fax:661-326-2282
Practice Address - Street 1:388 GLENBRIAR CIR
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-4144
Practice Address - Country:US
Practice Address - Phone:661-917-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18268363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA18268OtherPA LICENSE
CAMR1368186OtherDEA