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General NPI Number Information
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NPI Number | 1881456093
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Entity Type | Individual
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Provider Name | LOUIS JACQUES RAYMOND PA
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Gender | Male
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Dates
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Enumeration Date | 01/24/2024
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 2270 S RIDGEVIEW DR STE 204
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City | YUMA
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State | AZ
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Zip | 85364-8880
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Country | US
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Telephone | 646-255-3974
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Fax |
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Provider Business Mailing Address
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Address Line | 1820 E BELL DE MAR DR APT 137
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City | TEMPE
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State | AZ
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Zip | 85283-5738
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Country | US
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Telephone | 646-255-3974
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10128
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License Number State | AZ
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