Provider Demographics
NPI:1477714996
Name:RAAFAT MATTAR, MD, INC.
Entity Type:Organization
Organization Name:RAAFAT MATTAR, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAAFAT
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-580-8990
Mailing Address - Street 1:5267 WARNER AVE # 175
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4079
Mailing Address - Country:US
Mailing Address - Phone:714-521-9703
Mailing Address - Fax:714-312-5864
Practice Address - Street 1:5199 E PACIFIC COAST HWY STE 304
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3355
Practice Address - Country:US
Practice Address - Phone:562-493-2225
Practice Address - Fax:562-426-8929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A828520Medicaid
CA00A828520Medicaid
CAA82852Medicare PIN