Provider Demographics
NPI:1164612545
Name:RATINOFF, GREGG ALLEN
Entity Type:Individual
Prefix:MR
First Name:GREGG
Middle Name:ALLEN
Last Name:RATINOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 S. ENCINAL CYN. RD.
Mailing Address - Street 2:CAMP MILLER
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-2504
Mailing Address - Country:US
Mailing Address - Phone:213-258-6046
Mailing Address - Fax:
Practice Address - Street 1:433 S. ENCINAL CYN. RD.
Practice Address - Street 2:CAMP MILLER
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-2504
Practice Address - Country:US
Practice Address - Phone:213-258-6046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA49887106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health