Provider Demographics
NPI:1396908034
Name:ALEXANDER RASKIN INC A CALIFORNIA PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ALEXANDER RASKIN INC A CALIFORNIA PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:RASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-788-6784
Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:SUITE 1150
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-0000
Mailing Address - Country:US
Mailing Address - Phone:818-788-6784
Mailing Address - Fax:818-788-6785
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:SUITE 1150
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-0000
Practice Address - Country:US
Practice Address - Phone:818-788-6784
Practice Address - Fax:818-788-6785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64294207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty