MEDICARE: DR. ERIC B RAIMO MD

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	2084P0800X	Psychiatry Physician	A62169	CA

General Provider Information

NPI Number	:	1568429389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC B RAIMO MD

Provider Business Mailing Address
First Line	:	4147 ADAMS AVENUE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-2509
Country	:	US
Telephone Number	:	619-281-1932
Fax Number	:	619-281-1947

Provider Business Practice Location Address
First Line	:	4147 ADAMS AVENUE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-2509
Country	:	US
Telephone Number	:	619-281-1932
Fax Number	:	619-281-1947

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	06/21/2024

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