Provider Demographics
NPI:1154502144
Name:HOVSEPIAN, RAFFI V (MD)
Entity type:Individual
Prefix:DR
First Name:RAFFI
Middle Name:V
Last Name:HOVSEPIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAFI
Other - Middle Name:V
Other - Last Name:HOVSEPIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1401 AVOCADO AVE STE 810
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8708
Mailing Address - Country:US
Mailing Address - Phone:949-760-5047
Mailing Address - Fax:949-760-0978
Practice Address - Street 1:1401 AVOCADO AVE STE 810
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8708
Practice Address - Country:US
Practice Address - Phone:949-760-5047
Practice Address - Fax:949-760-0978
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-18
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96283282N00000X, 208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA96283OtherSTATE LICENSE