Provider Demographics
NPI:1770613978
Name:RIVKIN, LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:RIVKIN
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 1:465 N ROXBURY DR STE 803
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4211
Mailing Address - Country:US
Mailing Address - Phone:310-274-9954
Mailing Address - Fax:310-274-9450
Practice Address - Street 1:465 N ROXBURY DR STE 803
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4211
Practice Address - Country:US
Practice Address - Phone:310-274-9954
Practice Address - Fax:310-274-9450
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34985174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954220697OtherTAX ID #
CAC34985OtherLICENSE
CAC34985OtherLICENSE
CA954220697OtherTAX ID #
CAW11012Medicare ID - Type UnspecifiedPROVIDER #