MEDICARE: DR. RAED BARGOUT 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	207RC0000X	Cardiovascular Disease Physician	C53521	CA

General Provider Information

NPI Number	:	1962498410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAED BARGOUT MD

Provider Business Mailing Address
First Line	:	1300 N VERMONT AVE
Second Line	:	401
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6005
Country	:	US
Telephone Number	:	323-664-6535
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 N VERMONT AVE
Second Line	:	401
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6005
Country	:	US
Telephone Number	:	323-664-6535
Fax Number	:

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	04/14/2010

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