Provider Demographics
NPI:1760847800
Name:RAVID AVRAHAM M.D., INC.
Entity Type:Organization
Organization Name:RAVID AVRAHAM M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:AVRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-213-6543
Mailing Address - Street 1:PO BOX 7413
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90406-7413
Mailing Address - Country:US
Mailing Address - Phone:718-213-6543
Mailing Address - Fax:818-671-2225
Practice Address - Street 1:7150 TAMPA AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3700
Practice Address - Country:US
Practice Address - Phone:718-213-6543
Practice Address - Fax:818-671-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA137313208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty