MEDICARE: MR. RAFFAELE M CORBISIERO SR. 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	208600000X	Surgery Physician	A48113	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	:	1730172453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAFFAELE M CORBISIERO SR. MD

Provider Business Mailing Address
First Line	:	210S GRAND AVE 407
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-4290
Country	:	US
Telephone Number	:	626-914-5051
Fax Number	:	626-914-5068

Provider Business Practice Location Address
First Line	:	210S GRAND AVE 407
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-4290
Country	:	US
Telephone Number	:	626-914-5051
Fax Number	:	626-914-5068

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

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	08/21/2015

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