Provider Demographics
NPI:1558460634
Name:PARDAVE, RAUL A (MD)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:A
Last Name:PARDAVE
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 1:1530 E CHEVY CHASE DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4163
Mailing Address - Country:US
Mailing Address - Phone:818-545-7418
Mailing Address - Fax:818-844-0288
Practice Address - Street 1:1530 E CHEVY CHASE DR
Practice Address - Street 2:SUITE 207
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4163
Practice Address - Country:US
Practice Address - Phone:818-545-7418
Practice Address - Fax:818-844-0288
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A452430OtherMEDI CAL
CABP2119786OtherDEA
CAE48089Medicare UPIN
CAWA452439Medicare ID - Type Unspecified