Provider Demographics
NPI:1093061541
Name:BURWELL, RAYMOND ASPLUND (MA)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:ASPLUND
Last Name:BURWELL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:ALEX
Other - Middle Name:ASPLUND
Other - Last Name:BURWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1800 TULLY RD STE A2
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-2923
Mailing Address - Country:US
Mailing Address - Phone:209-622-1420
Mailing Address - Fax:209-491-0627
Practice Address - Street 1:1800 TULLY RD STE A2
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-2923
Practice Address - Country:US
Practice Address - Phone:209-622-1420
Practice Address - Fax:209-491-0627
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1093061541OtherBHS-MH