Healthcare Provider Details

I. General information

NPI: 1114300209
Provider Name (Legal Business Name): KAREN ANN P RAYOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 E ORANGEBURG AVE
MODESTO CA
95355-3370
US

IV. Provider business mailing address

PO BOX 577197
MODESTO CA
95357-7197
US

V. Phone/Fax

Practice location:
  • Phone: 98-503-5002
  • Fax: 808-974-4746
Mailing address:
  • Phone: 209-558-7248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA158600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: