Healthcare Provider Details

I. General information

NPI: 1164414652
Provider Name (Legal Business Name): RAYMOND I. FINK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR SUITE 404
LA MESA CA
91942-3017
US

IV. Provider business mailing address

8851 CENTER DR SUITE 404
LA MESA CA
91942-3017
US

V. Phone/Fax

Practice location:
  • Phone: 619-463-1293
  • Fax:
Mailing address:
  • Phone: 619-463-1293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG49984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: