Healthcare Provider Details

I. General information

NPI: 1578507679
Provider Name (Legal Business Name): RAOUL B DEL MAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6508 LONETREE BLVD SUITE 103
ROCKLIN CA
95765-5874
US

IV. Provider business mailing address

9380 COURTNEY WAY
ROSEVILLE CA
95747-9147
US

V. Phone/Fax

Practice location:
  • Phone: 916-771-5533
  • Fax: 916-771-5453
Mailing address:
  • Phone: 916-218-8808
  • Fax: 916-771-5453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA89166
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA89166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: