Healthcare Provider Details

I. General information

NPI: 1043404387
Provider Name (Legal Business Name): RAVEN ORTHOPAEDICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3413 W PACIFIC AVE STE 100
BURBANK CA
91505-1598
US

IV. Provider business mailing address

3413 W PACIFIC AVE STE 100
BURBANK CA
91505-1598
US

V. Phone/Fax

Practice location:
  • Phone: 818-841-3936
  • Fax: 818-841-5974
Mailing address:
  • Phone: 818-841-3936
  • Fax: 818-841-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA66365
License Number StateCA

VIII. Authorized Official

Name: DR. RAYMOND B. RAVEN III
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-841-3936