Provider Demographics
NPI:1871615823
Name:REFF, ALBERT A (MD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:A
Last Name:REFF
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 1:510 N PROSPECT AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3000
Mailing Address - Country:US
Mailing Address - Phone:310-372-4646
Mailing Address - Fax:
Practice Address - Street 1:510 N PROSPECT AVE STE 105
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3000
Practice Address - Country:US
Practice Address - Phone:310-372-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25715174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42769Medicare UPIN