Provider Demographics
NPI:1952308124
Name:RAPEPORT, KEVIN BERNARD (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:BERNARD
Last Name:RAPEPORT
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 1:8851 CENTER DR
Mailing Address - Street 2:STE 401
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3017
Mailing Address - Country:US
Mailing Address - Phone:619-668-1550
Mailing Address - Fax:619-668-1554
Practice Address - Street 1:8851 CENTER DR
Practice Address - Street 2:STE 401
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3017
Practice Address - Country:US
Practice Address - Phone:619-668-1550
Practice Address - Fax:619-668-1554
Is Sole Proprietor?:No
Enumeration Date:2005-07-04
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43603207RC0000X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A436030Medicaid
CA060016040OtherRR MEDICARE
CA00A436030OtherBLUE SHIELD
CA00A436030OtherBLUE SHIELD
CAA61774Medicare UPIN
CAWA43603HMedicare PIN