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NPI Code Detail

MEDICARE: MR. RAYMONDAU WOODARD JR.

MEDICARE: MR. RAYMONDAU WOODARD JR.
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
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1881538106
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RAYMONDAU WOODARD JR.
Provider Business Mailing Address
First Line : 1995 DE CARMEN DR
Second Line :
City : COLTON
State : CA
Zip : 92324-6622
Country : US
Telephone Number : 909-303-0754
Fax Number :
Provider Business Practice Location Address
First Line : 4508 N SIERRA WAY
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92407-3854
Country : US
Telephone Number : 909-683-6022
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2026
Last Update Date : 04/16/2026

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