Provider Demographics
NPI:1003836974
Name:PENA, RAYMOND J (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:J
Last Name:PENA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1415 N ACACIA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:REEDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93654-2449
Mailing Address - Country:US
Mailing Address - Phone:559-638-8187
Mailing Address - Fax:559-638-3883
Practice Address - Street 1:1415 N ACACIA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654-2449
Practice Address - Country:US
Practice Address - Phone:559-638-8187
Practice Address - Fax:559-638-3883
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2015-02-26
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Provider Licenses
StateLicense IDTaxonomies
CAA61340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG86184Medicare UPIN