1992906093 NPI number — T JOSEPH RAOOF MD INC

Table of content: (NPI 1992906093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992906093 NPI number — T JOSEPH RAOOF MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
T JOSEPH RAOOF MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992906093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16133 VENTURA BLVD
Provider Second Line Business Mailing Address:
#340
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-788-5060
Provider Business Mailing Address Fax Number:
818-783-8676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16133 VENTURA BLVD
Provider Second Line Business Practice Location Address:
#340
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-788-5060
Provider Business Practice Location Address Fax Number:
818-783-8676
Provider Enumeration Date:
05/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAOOF
Authorized Official First Name:
TOORAJ
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
818-788-5060

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  A42698 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: A42698 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A426981 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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