Healthcare Provider Details

I. General information

NPI: 1013028190
Provider Name (Legal Business Name): VICKI RAPAPORT, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N BEDFORD DR STE 306
BEVERLY HILLS CA
90210-4320
US

IV. Provider business mailing address

436 N BEDFORD DR STE 306
BEVERLY HILLS CA
90210-4320
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-4401
  • Fax: 310-274-5194
Mailing address:
  • Phone: 310-274-4401
  • Fax: 310-274-5194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: VICKI RAPAPORT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-274-4401