Provider Demographics
NPI:1386707636
Name:POLIAKIN, RAYMOND ISRAEL (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:ISRAEL
Last Name:POLIAKIN
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 1:227 WEST JANSS ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360
Mailing Address - Country:US
Mailing Address - Phone:805-497-8820
Mailing Address - Fax:805-496-2072
Practice Address - Street 1:227 W JANSS RD STE 300
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1885
Practice Address - Country:US
Practice Address - Phone:805-497-8820
Practice Address - Fax:805-496-2072
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42576207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG42576Medicare ID - Type Unspecified
A49024Medicare UPIN