Provider Demographics
NPI:1982791562
Name:GEVORKIAN, RAFAYEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAYEL
Middle Name:
Last Name:GEVORKIAN
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 1:5129 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5715
Mailing Address - Country:US
Mailing Address - Phone:323-663-9009
Mailing Address - Fax:323-663-5550
Practice Address - Street 1:5129 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5715
Practice Address - Country:US
Practice Address - Phone:323-663-9009
Practice Address - Fax:323-663-5550
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41672207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85683Medicare UPIN
CAA416720Medicare ID - Type UnspecifiedRAFAYEL GEVORKIAN M.D.