Healthcare Provider Details

I. General information

NPI: 1063839934
Provider Name (Legal Business Name): RAYMUNDO MIGUEL GARCIA LORA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E KATELLA AVE STE P
ORANGE CA
92867-5150
US

IV. Provider business mailing address

1920 E KATELLA AVE STE P
ORANGE CA
92867-5150
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-3060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA137841
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: