Provider Demographics
NPI:1366472185
Name:PISKOVA, RAYNA (MD)
Entity Type:Individual
Prefix:
First Name:RAYNA
Middle Name:
Last Name:PISKOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 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:800-955-6412
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:800-955-6412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52376207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00086332OtherMEDICARE RAILROAD
CA00A523760Medicaid
CA00A523760Medicaid
CA00A523760Medicare PIN
CA5555030001Medicare NSC