Provider Demographics
NPI:1629181730
Name:RAVIN, ROSS R (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:R
Last Name:RAVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:800-883-7243
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:8670 WILSHIRE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2930
Practice Address - Country:US
Practice Address - Phone:310-275-1646
Practice Address - Fax:310-659-2333
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81544207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G815440Medicaid
CAWG81544EMedicare PIN
CA00G815440Medicaid
CAG50353Medicare UPIN