Provider Demographics
NPI:1750755294
Name:DAMON B. RASKIN MD INC
Entity type:Organization
Organization Name:DAMON B. RASKIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:RASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-459-4333
Mailing Address - Street 1:881 ALMA REAL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3740
Mailing Address - Country:US
Mailing Address - Phone:310-459-4333
Mailing Address - Fax:310-230-1953
Practice Address - Street 1:881 ALMA REAL DR STE 103
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3740
Practice Address - Country:US
Practice Address - Phone:310-459-4333
Practice Address - Fax:310-230-1953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0813334305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization