MEDICARE: DR. LEONARD JAMES RAIMONDO D.D.S.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	32892	CA

General Provider Information

NPI Number	:	1114126497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD JAMES RAIMONDO D.D.S.

Provider Business Mailing Address
First Line	:	16756 CHINO CORONA RD
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92880-9508
Country	:	US
Telephone Number	:	909-597-1771
Fax Number	:	909-606-4925

Provider Business Practice Location Address
First Line	:	16756 CHINO CORONA RD
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92880-9508
Country	:	US
Telephone Number	:	909-597-1771
Fax Number	:	909-606-4925

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

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	07/16/2007

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