Healthcare Provider Details

I. General information

NPI: 1447233622
Provider Name (Legal Business Name): FRANCISCO LARDIZAHAL RAVAGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 AIRPORT BLVD
FREEDOM CA
95019-2917
US

IV. Provider business mailing address

99 AIRPORT BLVD
FREEDOM CA
95019-2917
US

V. Phone/Fax

Practice location:
  • Phone: 831-724-7521
  • Fax: 831-724-9566
Mailing address:
  • Phone: 831-724-7521
  • Fax: 831-724-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA49230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: