Provider Demographics
NPI:1255490678
Name:K. MITCHELL NAFICY MD INC
Entity Type:Organization
Organization Name:K. MITCHELL NAFICY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:K. MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAFICY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-489-0773
Mailing Address - Street 1:27512 CALLE ARROYO
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2753
Mailing Address - Country:US
Mailing Address - Phone:949-489-0773
Mailing Address - Fax:949-489-9342
Practice Address - Street 1:27512 CALLE ARROYO
Practice Address - Street 2:SUITE A
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2753
Practice Address - Country:US
Practice Address - Phone:949-489-0773
Practice Address - Fax:949-489-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72771207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G727710Medicaid
CA00G727710Medicaid