MEDICARE: RAYMOND MICHAEL BORN

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1801542121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND MICHAEL BORN

Provider Business Mailing Address
First Line	:	4265 S NORMANDIE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2324
Country	:	US
Telephone Number	:	213-278-8634
Fax Number	:

Provider Business Practice Location Address
First Line	:	4265 S NORMANDIE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2324
Country	:	US
Telephone Number	:	213-278-8634
Fax Number	:

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

Provider Enumeration Date	:	02/24/2022
Last Update Date	:	02/24/2022

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Directions to “ RAYMOND MICHAEL BORN ” Practice Location

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