Healthcare Provider Details

I. General information

NPI: 1043424781
Provider Name (Legal Business Name): RAYNA PISKOVA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 S I ST SUITE C
MADERA CA
93637-4660
US

IV. Provider business mailing address

509 S I ST SUITE C
MADERA CA
93637-4660
US

V. Phone/Fax

Practice location:
  • Phone: 559-675-1715
  • Fax:
Mailing address:
  • Phone: 559-675-1715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberA52376
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberA52376
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA52376
License Number StateCA

VIII. Authorized Official

Name: RAYNA PISKOVA
Title or Position: OWNER
Credential: M.D.
Phone: 661-869-2600