MEDICARE: DR. BASIL RAPOPORT M.D.

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	A25179	CA

General Provider Information

NPI Number	:	1053349670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BASIL RAPOPORT M.D.

Provider Business Mailing Address
First Line	:	468 21ST PLACE
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90402
Country	:	US
Telephone Number	:	310-994-4594
Fax Number	:	310-899-0408

Provider Business Practice Location Address
First Line	:	468 21ST PLACE
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90402
Country	:	US
Telephone Number	:	310-994-4594
Fax Number	:	310-967-1744

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	12/13/2021

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