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NPI Code Detail

MEDICARE: RAYMOND L MABERRY

MEDICARE: RAYMOND L MABERRY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1174834725
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAYMOND L MABERRY
Provider Business Mailing Address
First Line : 400 N MOUNTAIN AVE STE 208
Second Line :
City : UPLAND
State : CA
Zip : 91786-5177
Country : US
Telephone Number : 909-303-3315
Fax Number :
Provider Business Practice Location Address
First Line : 1206 W 14TH ST
Second Line :
City : UPLAND
State : CA
Zip : 91786-2517
Country : US
Telephone Number : 909-360-8526
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2010
Last Update Date : 02/24/2023

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Directions to “ RAYMOND L MABERRY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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