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General NPI Number Information
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NPI Number | 1255845962
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Entity Type | Organization
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Legal Business Name | ERIC B RAIMO M D A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/17/2017
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 4147 ADAMS AVE
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City | SAN DIEGO
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State | CA
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Zip | 92116-2509
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Country | US
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Telephone | 619-850-9889
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Fax | 619-281-1947
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Provider Business Mailing Address
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Address Line | 4147 ADAMS AVE
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City | SAN DIEGO
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State | CA
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Zip | 92116-2509
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Country | US
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Telephone | 619-850-9889
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Fax | 619-281-1947
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC B RAIMO
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Credential | MD
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Telephone | 619-281-1932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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