Provider Demographics
NPI:1275609588
Name:RAZA, SYED JAFAR (MD)
Entity Type:Individual
Prefix:MR
First Name:SYED
Middle Name:JAFAR
Last Name:RAZA
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:PO BOX 2680
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-2680
Mailing Address - Country:US
Mailing Address - Phone:760-242-7560
Mailing Address - Fax:760-242-7563
Practice Address - Street 1:15962 QUANTICO RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1302
Practice Address - Country:US
Practice Address - Phone:760-242-7560
Practice Address - Fax:760-242-7563
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5121207RC0000X, 207RI0011X
CAA52952207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A59520Medicaid
CA00A529521Medicare PIN
CAG49383Medicare UPIN