Provider Demographics
NPI:1255726485
Name:RAPHAEL, OREN SIMANTOV (MD)
Entity type:Individual
Prefix:DR
First Name:OREN
Middle Name:SIMANTOV
Last Name:RAPHAEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6345 BALBOA BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1500
Mailing Address - Country:US
Mailing Address - Phone:818-774-3040
Mailing Address - Fax:
Practice Address - Street 1:2021 SANTA MONICA BLVD STE 245E
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2132
Practice Address - Country:US
Practice Address - Phone:310-829-8975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA152831208M00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist