Provider Demographics
NPI:1093076291
Name:HERBERT I. RAPPAPORT, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:HERBERT I. RAPPAPORT, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:IRWIN
Authorized Official - Last Name:RAPPAPORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-440-0966
Mailing Address - Street 1:158 N ANITA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-2720
Mailing Address - Country:US
Mailing Address - Phone:310-440-0966
Mailing Address - Fax:310-440-0967
Practice Address - Street 1:158 N ANITA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-2720
Practice Address - Country:US
Practice Address - Phone:310-440-0966
Practice Address - Fax:310-440-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG10471261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90077Medicare UPIN