Provider Demographics
NPI:1154617306
Name:RAO, RAVISHANKAR E (MD)
Entity type:Individual
Prefix:DR
First Name:RAVISHANKAR
Middle Name:E
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 CENTER DR STE 500
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3033
Mailing Address - Country:US
Mailing Address - Phone:619-740-5757
Mailing Address - Fax:
Practice Address - Street 1:8851 CENTER DR STE 500
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3033
Practice Address - Country:US
Practice Address - Phone:619-740-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC202218207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine