Provider Demographics
NPI:1003873605
Name:RAPOZA, RUSSELL PAUL (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:PAUL
Last Name:RAPOZA
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 1:9940 TALBERT AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5153
Mailing Address - Country:US
Mailing Address - Phone:714-378-5507
Mailing Address - Fax:714-378-5506
Practice Address - Street 1:9940 TALBERT AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5153
Practice Address - Country:US
Practice Address - Phone:714-378-5507
Practice Address - Fax:714-378-5506
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71959174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G719590Medicaid
CA00G719590Medicaid
CAW15924Medicare ID - Type Unspecified