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General NPI Number Information
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NPI Number | 1003863283
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Entity Type | Individual
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Provider Name | LOUIS RAVITZ MD
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Gender | Male
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 2336 SANTA MONICA BLVD SUITE 207
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City | SANTA MONICA
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State | CA
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Zip | 90404
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Country | US
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Telephone | 310-828-9311
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Fax | 310-453-8533
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Provider Business Mailing Address
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Address Line | PO BOX 10609
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City | BURKBANK
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State | CA
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Zip | 91510-0609
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Country | US
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Telephone | 818-526-0200
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Fax | 818-526-0258
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | G24614
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License Number State | CA
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