Active NPI
Raia Ivanka Cimatu Novak, PA
- Physician Assistant
- Long Beach, CA
National Provider Identifier
1902260672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 53287
- Practice address
- 2572 Atlantic Ave
Long Beach, CA 90806-2751 - Phone
- (562) 774-0844
- Fax
- (562) 774-0848
- NPI assigned
- Apr 8, 2016
- Last updated
- Mar 8, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 53287 | CA | Primary |
Addresses
Primary practice location
2572 Atlantic Ave
Long Beach, CA 90806-2751
Mailing address
2572 Atlantic Ave
Long Beach, CA 90806-2751
Phone (562) 774-0844
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA53287 | Other | CA | PHYSICIAN ASSISTANT BOARD - STATE OF CALIFORNIA |
Other names 1
- Raia Ivanka Bulatao Cimatu
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
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53287 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1460073600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552003200000",
"number": "1902260672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2572 ATLANTIC AVE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908062751",
"telephone_number": "562-774-0844",
"fax_number": "562-774-0848"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2572 ATLANTIC AVE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908062751",
"telephone_number": "562-774-0844",
"fax_number": "562-774-0848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOVAK",
"first_name": "RAIA IVANKA",
"middle_name": "CIMATU",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-04-08",
"last_updated": "2019-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "53287",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIAN ASSISTANT BOARD - STATE OF CALIFORNIA",
"identifier": "PA53287",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "RAIA IVANKA",
"last_name": "CIMATU",
"middle_name": "BULATAO",
"credential": "PA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Long Beach, CA
- Kourosh Nourisamie, MD
- Nourish Golden LLC
- Padra Nourparvar, DO
- Nova Care Clinic, Inc
- Celeste R Novak
- Novakind Health Long Beach PC (novakind Health Long Beach Medical Corporation)
- Teresa Bolo Novales, NP
- Sese Novas, DC
- Novus Mindful Life Institute
- Now Clinical Family Services, Licensed Clinical Social Worker, Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.