MEDICARE: RAISA HEIFETS MD

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	208D00000X	General Practice Physician	A40429	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033208269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAISA HEIFETS MD

Provider Business Mailing Address
First Line	:	6027 YORK BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-3503
Country	:	US
Telephone Number	:	323-256-1556
Fax Number	:	323-256-1836

Provider Business Practice Location Address
First Line	:	6027 YORK BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-3503
Country	:	US
Telephone Number	:	323-256-1556
Fax Number	:	323-256-1836

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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Directions to “ RAISA HEIFETS MD” Practice Location

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