Provider Demographics
NPI:1699755264
Name:NAFICY, K MITCHELL (MD)
Entity type:Individual
Prefix:
First Name:K MITCHELL
Middle Name:
Last Name:NAFICY
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 1:30448 RANCHO VIEJO RD STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1572
Mailing Address - Country:US
Mailing Address - Phone:949-489-0773
Mailing Address - Fax:949-489-9342
Practice Address - Street 1:30448 RANCHO VIEJO RD STE 150
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1572
Practice Address - Country:US
Practice Address - Phone:949-489-0773
Practice Address - Fax:949-489-9342
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72771207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16951Medicare ID - Type Unspecified
CAF91741Medicare UPIN