Provider Demographics
NPI:1871809202
Name:SAFA, RAYA
Entity type:Individual
Prefix:
First Name:RAYA
Middle Name:
Last Name:SAFA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5073 HEATHER DR 106
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2868
Mailing Address - Country:US
Mailing Address - Phone:203-503-4702
Mailing Address - Fax:
Practice Address - Street 1:4201 ST. ANTOINE - UHC 5D - MAILBOX 226
Practice Address - Street 2:UNIVERSITY PEDIATRICIANS
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-4405
Practice Address - Fax:313-966-0665
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102266208000000X, 2080P0202X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine