Basic Information
| Provider Information | |||||||||
| NPI: | 1770126724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAYMUNDI | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | ELOISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39119 GIANT SEQUOIA ST | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935516005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618865089 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 23502 LYONS AVE STE 304A | ||||||||
| Address2: | |||||||||
| City: | NEWHALL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913212538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617020166 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2019 | ||||||||
| LastUpdateDate: | 10/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | CA | Y |
No ID Information.