Provider Demographics
NPI:1093871725
Name:LLAURADO, RAYMUND J (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMUND
Middle Name:J
Last Name:LLAURADO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:880 OAK PARK BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1821
Mailing Address - Country:US
Mailing Address - Phone:805-498-3235
Mailing Address - Fax:805-922-5927
Practice Address - Street 1:220 S PALISADE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8902
Practice Address - Country:US
Practice Address - Phone:805-922-6641
Practice Address - Fax:805-922-5927
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2011-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA56140207YX0905X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A561400Medicaid
CA00A561400Medicaid
WA56140BMedicare PIN
P00686413Medicare PIN
WA56140CMedicare PIN