MEDICARE: DR. REYNALDO RAYMUNDO ABEJUELA M.D.

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	2084P0800X	Psychiatry Physician	A42479	CA

General Provider Information

NPI Number	:	1225255185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REYNALDO RAYMUNDO ABEJUELA M.D.

Provider Business Mailing Address
First Line	:	2158 DERRINGER LN
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-3333
Country	:	US
Telephone Number	:	909-861-3358
Fax Number	:

Provider Business Practice Location Address
First Line	:	4990 ARLINGTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2757
Country	:	US
Telephone Number	:	951-343-3150
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/08/2007

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