Healthcare Provider Details

I. General information

NPI: 1487301701
Provider Name (Legal Business Name): AMADO RAYMUNDO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 ORANGE AVE
CORONADO CA
92118-2619
US

IV. Provider business mailing address

836 ORANGE AVE
CORONADO CA
92118-2619
US

V. Phone/Fax

Practice location:
  • Phone: 619-435-6585
  • Fax:
Mailing address:
  • Phone: 619-435-6585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number6996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: