Provider Demographics
NPI:1508995820
Name:BAKAITIS, RAYMOND FRANCIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:FRANCIS
Last Name:BAKAITIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2566 OVERLAND AVE
Mailing Address - Street 2:SUITE 780
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3366
Mailing Address - Country:US
Mailing Address - Phone:310-841-6870
Mailing Address - Fax:
Practice Address - Street 1:2566 OVERLAND AVE
Practice Address - Street 2:SUITE 780
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-3366
Practice Address - Country:US
Practice Address - Phone:310-841-6870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7383103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR82597Medicare UPIN
CACP7383BMedicare ID - Type Unspecified