Provider Demographics
NPI:1285821330
Name:RAVITZ, ADRIAN B (CO)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:B
Last Name:RAVITZ
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12540 OAKS NORTH DR
Mailing Address - Street 2:SUITE B3
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-1608
Mailing Address - Country:US
Mailing Address - Phone:858-943-1691
Mailing Address - Fax:
Practice Address - Street 1:12540 OAKS NORTH DR
Practice Address - Street 2:SUITE B3
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-1608
Practice Address - Country:US
Practice Address - Phone:858-943-1691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist