Basic Information
| Provider Information | |||||||||
| NPI: | 1760847800 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAVID AVRAHAM M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7413 | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904067413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182136543 | ||||||||
| FaxNumber: | 8186712225 | ||||||||
| Practice Location | |||||||||
| Address1: | 7150 TAMPA AVE | ||||||||
| Address2: | |||||||||
| City: | RESEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913353700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182136543 | ||||||||
| FaxNumber: | 8186712225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2015 | ||||||||
| LastUpdateDate: | 09/09/2016 | ||||||||
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| AuthorizedOfficialLastName: | AVRAHAM | ||||||||
| AuthorizedOfficialFirstName: | RAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7182136543 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | A137313 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.