Provider Demographics
NPI:1689919938
Name:RAUL A. VERNAL M.D. INC.
Entity Type:Organization
Organization Name:RAUL A. VERNAL M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VERNAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-374-4570
Mailing Address - Street 1:777 KNOWLES DR
Mailing Address - Street 2:SUITE #10
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1417
Mailing Address - Country:US
Mailing Address - Phone:408-374-4570
Mailing Address - Fax:
Practice Address - Street 1:777 KNOWLES DR
Practice Address - Street 2:SUITE #10
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1417
Practice Address - Country:US
Practice Address - Phone:408-374-4570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25770174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24565Medicare UPIN
CA00A257700Medicare PIN