Provider Demographics
NPI:1073792446
Name:RAIKHEL, MARINA (MD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:RAIKHEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:25043 NARBONNE AVE
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-2101
Mailing Address - Country:US
Mailing Address - Phone:310-373-8120
Mailing Address - Fax:424-203-8980
Practice Address - Street 1:25043 NARBONNE AVE
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-2101
Practice Address - Country:US
Practice Address - Phone:310-373-8120
Practice Address - Fax:424-203-8980
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA49056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABR2684341OtherDEA
CAF17117Medicare UPIN