1700170859 NPI number — MR. DENNIS PANSACOLA RAYMUNDO SFIDC

Table of content: MR. DENNIS PANSACOLA RAYMUNDO SFIDC (NPI 1700170859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700170859 NPI number — MR. DENNIS PANSACOLA RAYMUNDO SFIDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAYMUNDO
Provider First Name:
DENNIS
Provider Middle Name:
PANSACOLA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
SFIDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700170859
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35463 SUGAR MAPLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRIETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92563-7942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-764-3059
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
H100 SANTA MARGARITA RD
Provider Second Line Business Practice Location Address:
NAVAL HOSPITAL CAMP PENDLETON
Provider Business Practice Location Address City Name:
OCEAN SIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-763-6529
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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