Individual provider Active NPI

Ryan Michael Rey Raroque, DPT

  • Physical Therapist
  • Beverly Hills, CA
National Provider Identifier
1053948018
Registry record updated Mar 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
298270 Issued in CA
Practice address
9675 Brighton Way Ste 250
Beverly Hills, CA 90210-5180
Phone
(310) 278-5337
NPI assigned
Mar 26, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 298270 CA Primary

Addresses

Primary practice location

9675 Brighton Way Ste 250
Beverly Hills, CA 90210-5180

Mailing address

4543 Conchita Way
Tarzana, CA 91356-4903
Phone (818) 943-0051

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
298270CAMDPhysical Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585180800000",
    "number": "1053948018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4543 CONCHITA WAY",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913564903",
            "telephone_number": "818-943-0051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9675 BRIGHTON WAY STE 250",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902105180",
            "telephone_number": "310-278-5337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAROQUE",
        "first_name": "RYAN MICHAEL",
        "middle_name": "REY",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-26",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "298270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.