Provider Demographics
NPI:1417033374
Name:RAYMUNDO-DEVERA, CARMELITA ANTOQUIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMELITA
Middle Name:ANTOQUIA
Last Name:RAYMUNDO-DEVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARMELITA
Other - Middle Name:ANTOQUIA
Other - Last Name:RAYMUNDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:685 CARNEGIE DR.
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3583
Mailing Address - Country:US
Mailing Address - Phone:909-890-0407
Mailing Address - Fax:909-890-0575
Practice Address - Street 1:16455 MAIN ST.
Practice Address - Street 2:SUITE 1
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345
Practice Address - Country:US
Practice Address - Phone:760-947-2161
Practice Address - Fax:760-947-3673
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55746208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics