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General NPI Number Information
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NPI Number | 1891968509
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Entity Type | Organization
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Legal Business Name | RAVEN ORTHOPAEDIC, INC
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 12/15/2008
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Provider Practice Location Address
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Address Line | 340 DARDANELLI LN SUITE 14A
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City | LOS GATOS
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State | CA
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Zip | 95032-1418
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Country | US
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Telephone | 408-866-0441
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Fax | 408-866-1926
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Provider Business Mailing Address
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Address Line | 2625 W ALAMEDA AVE SUITE 116
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City | BURBANK
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State | CA
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Zip | 91505-4806
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Country | US
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Telephone | 818-841-3936
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Fax | 818-841-5974
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RAYMOND B RAVEN III
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Credential | M.D.
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Telephone | 818-841-3936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | A66365
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License Number State | CA
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