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General NPI Number Information
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NPI Number | 1477857571
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Entity Type | Organization
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Legal Business Name | RAYMUNDO DENTAL PRACTICE INC
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 170 E FOOTHILL BLVD STE B
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City | ARCADIA
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State | CA
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Zip | 91006-2569
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Country | US
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Telephone | 626-359-4595
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Fax | 626-359-4596
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Provider Business Mailing Address
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Address Line | 170 E FOOTHILL BLVD STE B
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City | ARCADIA
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State | CA
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Zip | 91006-2569
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Country | US
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Telephone | 626-359-4595
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Fax | 626-359-4596
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Authorized Official
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Title or Position | DENTIST, OWNER, PRESIDENT
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Name | MRS. RONALYN T. RAYMUNDO
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Credential | D.D.S.
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Telephone | 626-359-4595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 40194
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License Number State | CA
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