Provider Demographics
NPI:1770088486
Name:RAFFO, MUKHLIS
Entity type:Individual
Prefix:
First Name:MUKHLIS
Middle Name:
Last Name:RAFFO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 VERNON WAY STE B
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1928
Mailing Address - Country:US
Mailing Address - Phone:619-741-0611
Mailing Address - Fax:
Practice Address - Street 1:289 VERNON WAY STE B
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1928
Practice Address - Country:US
Practice Address - Phone:619-741-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)