Provider Demographics
NPI:1396756060
Name:SAFIANOFF, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SAFIANOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RELIEZ VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-1905
Mailing Address - Country:US
Mailing Address - Phone:925-939-4068
Mailing Address - Fax:925-939-7424
Practice Address - Street 1:2485 HIGH SCHOOL AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1819
Practice Address - Country:US
Practice Address - Phone:925-676-2942
Practice Address - Fax:925-676-7108
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG227470207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G227470Medicaid
CA290014256OtherRAILROAD MEDICARE
CAGR0064710Medicaid
CAZZZ00582ZMedicare ID - Type UnspecifiedGROUP ID NUMBER
CA00G227470Medicaid
CAGR0064710Medicaid