Provider Demographics
NPI:1396844395
Name:RAFIE, NIUSHA (MD)
Entity Type:Individual
Prefix:
First Name:NIUSHA
Middle Name:
Last Name:RAFIE
Suffix:
Gender:F
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 1764
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-1764
Mailing Address - Country:US
Mailing Address - Phone:415-677-2325
Mailing Address - Fax:415-677-2444
Practice Address - Street 1:845 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4851
Practice Address - Country:US
Practice Address - Phone:415-677-2325
Practice Address - Fax:415-677-2444
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALA96782174400000X
CAA967822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A967820Medicaid
CA00A967821Medicare PIN