Provider Demographics
NPI:1518066141
Name:LAWRENCE RIVKIN MD A MED CORP
Entity Type:Organization
Organization Name:LAWRENCE RIVKIN MD A MED CORP
Other - Org Name:DERMATOLOGY ASSOICATES MEDCIAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANZALDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-274-9954
Mailing Address - Street 1:465 N ROXBURY DR STE 803
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4211
Mailing Address - Country:US
Mailing Address - Phone:310-274-9954
Mailing Address - Fax:310-274-9450
Practice Address - Street 1:465 N ROXBURY DR STE 803
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4211
Practice Address - Country:US
Practice Address - Phone:310-274-9954
Practice Address - Fax:310-274-9450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG56013OtherSTATE LICENSE
CAG76489OtherSTATE LICENSE
CAWC34985BOtherMEDICARE PROVIDER #
CAC34985OtherSTATE LICENSE
CAW11012OtherGROUP # MEDICARE
CAG042740OtherSTATE LICENSE
CAW11012OtherGROUP # MEDICARE
CAAW9414967OtherDEA #
CABH3758123OtherDEA #
CAG042740OtherSTATE LICENSE
CAW11012OtherGROUP # MEDICARE
CAW11012OtherGROUP # MEDICARE
CABH0147719OtherDEA #
CABH3758123OtherDEA #
CAG65548Medicare UPIN
CAWG42740BMedicare UPIN
CAWC34985BOtherMEDICARE PROVIDER #