Healthcare Provider Details

I. General information

NPI: 1255400248
Provider Name (Legal Business Name): RAIMEL YTURRALDE PEREZ-PASILIAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAIMEL PELAGIA YTURRALDE PEREZ M.D.

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12574 CENTRAL AVE
CHINO CA
91710-3507
US

IV. Provider business mailing address

7940 SERENITY FALLS RD
CORONA CA
92880-3396
US

V. Phone/Fax

Practice location:
  • Phone: 909-627-7433
  • Fax: 562-365-3532
Mailing address:
  • Phone: 626-674-5284
  • Fax: 562-365-3532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA86687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: