=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932510807
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAYMOND BADILLO, M.D., A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2014
-----------------------------------------------------
Last Update Date | 05/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 436 N BEDFORD DRIVE #305
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-508-6785
-----------------------------------------------------
Fax | 310-546-5797
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 MALAGA PL. E.
-----------------------------------------------------
City | MANHATTAN BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-546-5797
-----------------------------------------------------
Fax | 310-546-5797
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RAYMOND BADILLO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 310-508-6785
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | G52698
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------