Healthcare Provider Details

I. General information

NPI: 1104022821
Provider Name (Legal Business Name): JEFFREY RAWNSLEY, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10921 WILSHIRE BLVD STE 611
LOS ANGELES CA
90024-4001
US

IV. Provider business mailing address

10921 WILSHIRE BLVD STE 611
LOS ANGELES CA
90024-4001
US

V. Phone/Fax

Practice location:
  • Phone: 310-208-8888
  • Fax:
Mailing address:
  • Phone: 310-208-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberG78843
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY DALE RAWNSLEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-433-5816