MEDICARE: VICKI RAPAPORT, M.D., A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1013028190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICKI RAPAPORT, M.D., A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	436 N BEDFORD DR STE 306
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4320
Country	:	US
Telephone Number	:	310-274-4401
Fax Number	:	310-274-5194

Provider Business Practice Location Address
First Line	:	436 N BEDFORD DR STE 306
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4320
Country	:	US
Telephone Number	:	310-274-4401
Fax Number	:	310-274-5194

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VICKI RAPAPORT
Credential	:	M.D.
Telephone Number	:	310-274-4401

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/09/2020

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