Healthcare Provider Details

I. General information

NPI: 1093871725
Provider Name (Legal Business Name): RAYMUND J LLAURADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S PALISADE DR SUITE 102
SANTA MARIA CA
93454-8902
US

IV. Provider business mailing address

880 OAK PARK BLVD SUITE 102
ARROYO GRANDE CA
93420-1821
US

V. Phone/Fax

Practice location:
  • Phone: 805-922-6641
  • Fax: 805-922-5927
Mailing address:
  • Phone: 805-498-3235
  • Fax: 805-922-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA56140
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberA56140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: