Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A96826 | CA |
N | 111NI0900X | Internist | A96826 | CA |
Y | 207RI0200X | Infectious Disease | A96826 | CA |
NPI | 1033153028 |
---|---|
Provider Name | Raphael Jeremiah Landovitz |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90035-4709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 16/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A968260 | (05) | CA |