Provider Demographics
NPI:1407875123
Name:RAPPAPORT, HERBERT I (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:I
Last Name:RAPPAPORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15342 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-2152
Mailing Address - Country:US
Mailing Address - Phone:310-644-8400
Mailing Address - Fax:310-644-8424
Practice Address - Street 1:15342 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260
Practice Address - Country:US
Practice Address - Phone:310-644-8400
Practice Address - Fax:310-644-8424
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG10471207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G104710Medicaid
G10471Medicare ID - Type Unspecified
CA00G104710Medicaid