Provider Demographics
NPI:1043270226
Name:JAFARI-RASKE, GITA (MD)
Entity type:Individual
Prefix:
First Name:GITA
Middle Name:
Last Name:JAFARI-RASKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GITA
Other - Middle Name:
Other - Last Name:JAFARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3115 S PRICE RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-3544
Mailing Address - Country:US
Mailing Address - Phone:480-926-0170
Mailing Address - Fax:
Practice Address - Street 1:3115 S PRICE RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-3544
Practice Address - Country:US
Practice Address - Phone:480-926-0170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ970138Medicaid
AZZ173067Medicare PIN
AZZ119282Medicare PIN
AZ970138Medicaid
AZI40670Medicare UPIN