Provider Demographics
NPI:1023442118
Name:RAFIFAR, MOHAMMAD (DC)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:RAFIFAR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 S CATALINA AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5511
Mailing Address - Country:US
Mailing Address - Phone:310-383-2330
Mailing Address - Fax:
Practice Address - Street 1:1820 S CATALINA AVE STE 108
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5511
Practice Address - Country:US
Practice Address - Phone:310-383-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22130111NS0005X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC22130OtherCHIROPRACTIC