Provider Demographics
NPI:1902823339
Name:DAVOOD VAFAI MD INCORPORATED
Entity Type:Organization
Organization Name:DAVOOD VAFAI MD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:VAFAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-341-3688
Mailing Address - Street 1:PO BOX 2008
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92286
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:760-601-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50294207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A502940OtherBLUE CROSS
CA00A502940Medicaid
CA00A502940OtherBLUE SHIELD
CA00A502940OtherBLUE CROSS
CA00A502940OtherBLUE SHIELD
CA00A502940Medicaid