Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 48850 | CA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | A102021 | CA |
N | 207YS0123X | Facial Plastic Surgeon | A102021 | CA |
NPI | 1063609030 |
---|---|
Provider Name | Dr. Alexander Rabinovich |
First Address | Roseville, CA 95747-6336 |
Second Address | Roseville, CA 95747-6336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2007 |
Last Update Date | 27/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
246279 | MEDICAL LICENSE (01) | NY |
48850 | DENTAL LICENSE (01) | CA |
A102021 | MEDICAL LICENSE (01) | CA |