Provider Demographics
NPI:1043424781
Name:RAYNA PISKOVA MD INC
Entity Type:Organization
Organization Name:RAYNA PISKOVA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PISKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-869-2600
Mailing Address - Street 1:509 S I ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4660
Mailing Address - Country:US
Mailing Address - Phone:559-675-1715
Mailing Address - Fax:
Practice Address - Street 1:509 S I ST
Practice Address - Street 2:SUITE C
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4660
Practice Address - Country:US
Practice Address - Phone:559-675-1715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52376152W00000X, 207W00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A523760Medicaid
CA00A523760Medicare ID - Type Unspecified
CA00A523760Medicaid