Provider Demographics
NPI:1558346130
Name:RAVIN, PAULA D (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:D
Last Name:RAVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:D
Other - Last Name:ROTHSCHILD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14804 MAGNOLIA BLVD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1313
Mailing Address - Country:US
Mailing Address - Phone:508-728-7337
Mailing Address - Fax:310-206-9819
Practice Address - Street 1:300 MEDICAL PLAZA
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY B 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-206-3183
Practice Address - Fax:310-206-9819
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA597732084N0400X
CAG456562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3036456Medicaid
MAA14182Medicare UPIN
MAJ07677Medicare PIN