Healthcare Provider Details

I. General information

NPI: 1669544326
Provider Name (Legal Business Name): JYOTSANA P. RAYGOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANA P. RAYGOR M.D.

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 GLADSTONE DR
PITTSBURG CA
94565-5126
US

IV. Provider business mailing address

PO BOX 22210
OAKLAND CA
94623-2210
US

V. Phone/Fax

Practice location:
  • Phone: 925-431-2100
  • Fax: 925-431-1234
Mailing address:
  • Phone: 510-535-4000
  • Fax: 510-535-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA41862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: