Provider Demographics
NPI:1760680896
Name:JAFRI, FATIMA (MD)
Entity type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:
Last Name:JAFRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 JUNCTION BLVD
Mailing Address - Street 2:APT 915
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4983
Mailing Address - Country:US
Mailing Address - Phone:646-496-2887
Mailing Address - Fax:
Practice Address - Street 1:2261 DOUGLAS BLVD
Practice Address - Street 2:U.C.DAVIS MEDICAL GROUP
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3831
Practice Address - Country:US
Practice Address - Phone:916-783-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA104688207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program