Provider Demographics
NPI:1699815696
Name:SARAFIAN, RONEN
Entity Type:Individual
Prefix:MRS
First Name:RONEN
Middle Name:
Last Name:SARAFIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1215
Mailing Address - Country:US
Mailing Address - Phone:626-405-0440
Mailing Address - Fax:626-405-0450
Practice Address - Street 1:467 N LAKE AVENE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1215
Practice Address - Country:US
Practice Address - Phone:626-405-0440
Practice Address - Fax:626-405-0450
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101360332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4519410001Medicare NSC