=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083882567
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN A. RABIN, M.D., A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2008
-----------------------------------------------------
Last Update Date | 10/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3055 W ORANGE AVE STE 206
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92804-3154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-721-7547
-----------------------------------------------------
Fax | 714-229-5785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 171 PIER AVE # 253
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90405-5311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-721-7547
-----------------------------------------------------
Fax | 714-229-5785
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOHN A RABIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 310-721-7547
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | G83044
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------