Provider Demographics
NPI:1225080013
Name:GIRGIS, RAAFAT W (MD)
Entity Type:Individual
Prefix:DR
First Name:RAAFAT
Middle Name:W
Last Name:GIRGIS
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 1:901 DOVE ST
Mailing Address - Street 2:SUITE # 145
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3023
Mailing Address - Country:US
Mailing Address - Phone:949-955-1088
Mailing Address - Fax:949-955-1098
Practice Address - Street 1:901 DOVE ST
Practice Address - Street 2:SUITE # 145
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3023
Practice Address - Country:US
Practice Address - Phone:949-955-1088
Practice Address - Fax:949-955-1098
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA522072084P0800X, 2084P0802X, 2084A0401X, 2084P0015X, 2084F0202X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G15559Medicare UPIN
00A522071Medicare ID - Type Unspecified