Healthcare Provider Details

I. General information

NPI: 1457539868
Provider Name (Legal Business Name): RAYMUND J. LLAURADO, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 05/11/2009
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: 805-489-3235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberC2511936
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberC2511936
License Number StateCA

VIII. Authorized Official

Name: DR. RAYMUND J. LLAURADO
Title or Position: PRESIDENT
Credential: MD
Phone: 805-922-6641