Provider Demographics
NPI:1679508675
Name:RAICHEL-STIVI, SVETLANA (MD)
Entity type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:
Last Name:RAICHEL-STIVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4699 JAMBOREE RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2526
Mailing Address - Country:US
Mailing Address - Phone:949-557-0714
Mailing Address - Fax:
Practice Address - Street 1:4699 JAMBOREE RD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2526
Practice Address - Country:US
Practice Address - Phone:949-557-0714
Practice Address - Fax:949-557-0715
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA062626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine