Provider Demographics
NPI:1184746968
Name:TATEVOSSIAN, RAYMOND G (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:G
Last Name:TATEVOSSIAN
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:PO BOX 893520
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92589
Mailing Address - Country:US
Mailing Address - Phone:818-325-2088
Mailing Address - Fax:818-563-6201
Practice Address - Street 1:201 S BUENA VISTA ST STE 238
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4576
Practice Address - Country:US
Practice Address - Phone:818-325-2088
Practice Address - Fax:818-563-6201
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87098207L00000X, 207LP2900X, 208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A870980Medicaid
CA0A870980Medicaid