MEDICARE: RAYMOND R FRIPP MD

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	2080P0202X	Pediatric Cardiology Physician	C50679	CA
2	208000000X	Pediatrics Physician	C50679	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225036627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND R FRIPP MD

Provider Business Mailing Address
First Line	:	3020 CHILDRENS WAY
Second Line	:	MC5003
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4223
Country	:	US
Telephone Number	:	858-309-6303
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 CHILDRENS WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4223
Country	:	US
Telephone Number	:	858-966-5855
Fax Number	:

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

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	05/18/2016

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