MEDICARE: RAYMOND M VANCE M.D.

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
1	207X00000X	Orthopaedic Surgery Physician	G30115	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G30115	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1407818743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND M VANCE M.D.

Provider Business Mailing Address
First Line	:	3737 MORAGA AVE
Second Line	:	SUITE A106
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5404
Country	:	US
Telephone Number	:	858-270-4420
Fax Number	:	858-270-8199

Provider Business Practice Location Address
First Line	:	3737 MORAGA AVE
Second Line	:	SUITE A106
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5404
Country	:	US
Telephone Number	:	858-270-4420
Fax Number	:	858-270-8199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	06/23/2010

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Directions to “ RAYMOND M VANCE M.D.” Practice Location

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