Healthcare Provider Details

I. General information

NPI: 1275310559
Provider Name (Legal Business Name): RAYMOND GUAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FLORIDA AVE
NEW ORLEANS LA
70119-2714
US

IV. Provider business mailing address

1100 FLORIDA AVE
NEW ORLEANS LA
70119-2714
US

V. Phone/Fax

Practice location:
  • Phone: 702-774-2545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS-1287
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: