Provider Demographics
NPI:1124898077
Name:RAFIA, BAHMAN
Entity type:Individual
Prefix:
First Name:BAHMAN
Middle Name:
Last Name:RAFIA
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 1:1782 S SHERBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4329
Mailing Address - Country:US
Mailing Address - Phone:818-390-0799
Mailing Address - Fax:323-544-6493
Practice Address - Street 1:1931 PREUSS RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1106
Practice Address - Country:US
Practice Address - Phone:818-390-0799
Practice Address - Fax:323-544-6493
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197609316310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility