Provider Demographics
NPI:1003863283
Name:RAVITZ, LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:RAVITZ
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:PO BOX 10609
Mailing Address - Street 2:
Mailing Address - City:BURKBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91510-0609
Mailing Address - Country:US
Mailing Address - Phone:818-526-0200
Mailing Address - Fax:818-526-0258
Practice Address - Street 1:2336 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-828-9311
Practice Address - Fax:310-453-8533
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG24614207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A42317Medicare UPIN