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General NPI Number Information
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NPI Number | 1063075695
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Entity Type | Individual
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Provider Name | MYCHALL RAYMOND COLUMNA PAGULAYAN-SY MD
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Gender | Male
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Dates
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Enumeration Date | 04/18/2019
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 2660 W COVELL BLVD STE AB&C
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City | DAVIS
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State | CA
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Zip | 95616-5645
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Country | US
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Telephone | 530-747-3000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1188
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City | CORVALLIS
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State | OR
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Zip | 97339-1188
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | PG193628
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A195817
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License Number State | CA
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