Provider Demographics
NPI:1841407798
Name:JAFFER, RIAN NINA MANUEL (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:RIAN NINA
Middle Name:MANUEL
Last Name:JAFFER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Mailing Address - Street 1:15366 11TH ST
Mailing Address - Street 2:STE K
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3726
Mailing Address - Country:US
Mailing Address - Phone:760-245-6465
Mailing Address - Fax:
Practice Address - Street 1:11155 MOUNTAIN VIEW AVE STE 101
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3805
Practice Address - Country:US
Practice Address - Phone:909-796-2211
Practice Address - Fax:909-799-7646
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA16312363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant