MEDICARE: RAYMOND BADILLO 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	207L00000X	Anesthesiology Physician	G52698	CA

General Provider Information

NPI Number	:	1972579688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND BADILLO M.D.

Provider Business Mailing Address
First Line	:	6 MALAGA PL E
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-7202
Country	:	US
Telephone Number	:	310-546-5797
Fax Number	:	310-546-5797

Provider Business Practice Location Address
First Line	:	6 MALAGA PLACE EAST
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-7202
Country	:	US
Telephone Number	:	310-546-5797
Fax Number	:	310-546-5797

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	01/12/2015

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