Provider Demographics
NPI:1073362901
Name:SMART MSK
Entity type:Organization
Organization Name:SMART MSK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAVEN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:949-520-1013
Mailing Address - Street 1:27372 ALISO CREEK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5339
Mailing Address - Country:US
Mailing Address - Phone:949-520-1013
Mailing Address - Fax:949-791-4595
Practice Address - Street 1:27372 ALISO CREEK RD STE 100
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5339
Practice Address - Country:US
Practice Address - Phone:949-520-1013
Practice Address - Fax:949-791-4595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty