Provider Demographics
NPI:1578303376
Name:SARAFAN, SAFOURA (RDHAP)
Entity type:Individual
Prefix:
First Name:SAFOURA
Middle Name:
Last Name:SARAFAN
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 502164
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-2164
Mailing Address - Country:US
Mailing Address - Phone:858-880-6961
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 502164
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92150-2164
Practice Address - Country:US
Practice Address - Phone:858-880-6961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1055124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist