Provider Demographics
NPI:1851717318
Name:RAFUS, CLONGE WAYNE
Entity type:Individual
Prefix:
First Name:CLONGE
Middle Name:WAYNE
Last Name:RAFUS
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 1:2342 SHATTUCK AVE APT 112
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1517
Mailing Address - Country:US
Mailing Address - Phone:510-735-3004
Mailing Address - Fax:
Practice Address - Street 1:7200 BANCROFT AVE STE 267
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2408
Practice Address - Country:US
Practice Address - Phone:510-735-0864
Practice Address - Fax:510-647-9408
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No174400000XOther Service ProvidersSpecialist