Basic Information
| Provider Information | |||||||||
| NPI: | 1346216652 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVID | ||||||||
| FirstName: | RAYMUND | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9300 VALLEY CHILDRENS PL | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936368761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593536215 | ||||||||
| FaxNumber: | 5593536222 | ||||||||
| Practice Location | |||||||||
| Address1: | 9300 VALLEY CHILDRENS PL | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936368761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593536215 | ||||||||
| FaxNumber: | 5593536222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 06/25/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0402X | A106007 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
ID Information
| ID | Type | State | Issuer | Description | 388621200 | 05 | MN | MEDICAID | 000080878 | 01 | MN | PRIMEWEST | OTHER | 315G2RA | 01 | MN | BLUE CROSS | OTHER | 5549 | 01 | SD | DAKOTACARE | OTHER | 13414 | 05 | ND | MEDICAID | 46022474339 | 05 | NE | MEDICAID | 0500684 | 01 | SD | MEDICA | OTHER | 0500684 | 01 | SD | PREFERRED ONE | OTHER | 6100960 | 05 | SD | MEDICAID | 44850 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 2361647 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 246832 | 01 | SD | MIDLANDS CHOICE | OTHER | 315G2RA | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 370624200 | 01 | SD | DEPT OF LABOR | OTHER | HP53361 | 01 | SD | HEALTHPARTNERS | OTHER | 0592949 | 05 | IA | MEDICAID | 4994690 | 01 | SD | BLUE CROSS | OTHER | 57105I011 | 01 | SD | WPS TRICARE | OTHER |