Individual
JOHN M RAVITS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9500 GILMAN DR, MC 0624, LA JOLLA, CA 92093-5004
(858) 246-1154
Mailing address
9500 GILMAN DR, MC 0624, LA JOLLA, CA 92093-5004
(858) 246-1154
Taxonomy
Speciality
Code
Description
License number
State
2084N0008X
Neuromuscular Medicine (Psychiatry & Neurology) Physician
G43695
CA
2084N0400X
Neurology Physician
Primary
G43695
CA
2084N0600X
Clinical Neurophysiology Physician
G43695
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039590
LABOR & INDUSTRY
WA
05
—
1012830
—
WA
01
—
130018543
RAILROAD MEDICARE
—
01
—
MD360WA
ALASKA MEDICAID
WA
01
—
RA3636
BLUE SHIELD
WA
01
—
US0866284
AETNA/USHC SPECIALIST
WA
Enumeration date
08/16/2006
Last updated
08/22/2011
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