Provider Demographics
NPI:1053948018
Name:RAROQUE, RYAN MICHAEL REY (DPT)
Entity type:Individual
Prefix:DR
First Name:RYAN MICHAEL
Middle Name:REY
Last Name:RAROQUE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4543 CONCHITA WAY
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4903
Mailing Address - Country:US
Mailing Address - Phone:818-943-0051
Mailing Address - Fax:
Practice Address - Street 1:9675 BRIGHTON WAY STE 250
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5180
Practice Address - Country:US
Practice Address - Phone:310-278-5337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist