Provider Demographics
NPI:1598790669
Name:RAVINDRAN, RAKESH
Entity Type:Individual
Prefix:
First Name:RAKESH
Middle Name:
Last Name:RAVINDRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12035 BEVERLY BLVD
Mailing Address - Street 2:UNIT 1B
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-2940
Mailing Address - Country:US
Mailing Address - Phone:562-639-6094
Mailing Address - Fax:
Practice Address - Street 1:13203 HADLEY ST
Practice Address - Street 2:SUITE # 101-B
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4519
Practice Address - Country:US
Practice Address - Phone:562-945-6366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 73225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand