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NPI Code Detail

MEDICARE: JOHN RAVERA MD

MEDICARE: JOHN RAVERA 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
1208800000XUrology PhysicianA333549CA
2208800000XUrology PhysicianC28250CA

General Provider Information

NPI Number : 1558347674
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN RAVERA MD
Provider Business Mailing Address
First Line : 16100 SAND CANYON AVE
Second Line : STE 240
City : IRVINE
State : CA
Zip : 92618-3724
Country : US
Telephone Number : 949-640-2081
Fax Number : 949-640-1909
Provider Business Practice Location Address
First Line : 16100 SAND CANYON AVE
Second Line : STE 240
City : IRVINE
State : CA
Zip : 92618-3724
Country : US
Telephone Number : 949-640-2081
Fax Number : 949-640-1909
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2005
Last Update Date : 02/05/2020

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