Provider Demographics
NPI:1629066220
Name:VAFAI, DAVOOD (MD)
Entity Type:Individual
Prefix:
First Name:DAVOOD
Middle Name:
Last Name:VAFAI
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 1:40075 BOB HOPE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3942
Mailing Address - Country:US
Mailing Address - Phone:760-341-3688
Mailing Address - Fax:
Practice Address - Street 1:40075 BOB HOPE DR
Practice Address - Street 2:SUITE A
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3942
Practice Address - Country:US
Practice Address - Phone:760-341-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-09
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50294207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A502940OtherBLUE SHIELD
CA00A502940Medicaid
CA00A502940OtherBLUE CROSS
CA00A502940Medicaid
CA00A502940OtherBLUE CROSS