MEDICARE: DIJON A RAYFORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	101Y00000X	Counselor
3	103TF0000X	Family Psychologist
4	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1033806724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIJON A RAYFORD

Provider Business Mailing Address
First Line	:	8511 C AVE
Second Line	:
City	:	HESPERIA
State	:	CA
Zip	:	92345-5956
Country	:	US
Telephone Number	:	760-590-7715
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 E HOSPITALITY LN
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3546
Country	:	US
Telephone Number	:	760-590-7715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2023
Last Update Date	:	04/21/2023

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