Provider Demographics
NPI:1932346301
Name:RAYCHEV, RADOSLAV IVOV (MD)
Entity Type:Individual
Prefix:
First Name:RADOSLAV
Middle Name:IVOV
Last Name:RAYCHEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RADOSLAV
Other - Middle Name:IVOV
Other - Last Name:RAYTCHEV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:530 S HEWITT ST UNIT 333
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1913
Mailing Address - Country:US
Mailing Address - Phone:949-448-0302
Mailing Address - Fax:
Practice Address - Street 1:1211 W LA PALMA AVE STE 710
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2814
Practice Address - Country:US
Practice Address - Phone:949-448-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA10795952084N0400X, 2084V0102X, 2085R0204X
CAA1079592085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A1079590Medicaid
CADI728ZMedicare PIN