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General NPI Number Information
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NPI Number | 1366903502
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Entity Type | Individual
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Provider Name | SAMUEL ASA RAUCH MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 6633 TELEPHONE RD STE 212
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City | VENTURA
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State | CA
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Zip | 93003-5569
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Country | US
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Telephone | 805-644-9121
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Fax | 805-644-9131
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD SUITE 400
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City | LOS ANGELES
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State | CA
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Zip | 90095-5631
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Country | US
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Telephone | 310-301-8707
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Fax | 310-301-8751
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A176142
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License Number State | CA
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