# PRIMARYCARE ORTHO INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316360068
- **Authorized official:** DR. RAYMOND B. RAVEN III MD, MBA (DIRECTOR)
- **Authorized official phone:** (818) 841-3936

## Contact information

- **Practice address:** 2625 W ALAMEDA AVE STE 116, BURBANK, CA 91505-4815
- **Practice address phone:** (818) 841-3936
- **Practice address fax:** (818) 841-5974
- **Mailing address:** 2625 W ALAMEDA AVE STE 116, SUITE 116, BURBANK, CA 91505-4815
- **Mailing address phone:** (818) 841-3936
- **Mailing address fax:** (818) 841-5974

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | A66365 | CA | Yes |
| 207XS0106X | Orthopaedic Hand Surgery Physician | A66365 | CA | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | A66365 | CA | — |

## Other

- **Enumeration date:** 01/31/2014
- **Last updated:** 09/29/2015