Provider Demographics
NPI:1528014511
Name:SEBASTIAN, RAYNARD (MD)
Entity Type:Individual
Prefix:
First Name:RAYNARD
Middle Name:
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1490
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90801-1490
Mailing Address - Country:US
Mailing Address - Phone:888-237-1803
Mailing Address - Fax:818-587-2493
Practice Address - Street 1:2801 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1737
Practice Address - Country:US
Practice Address - Phone:562-933-2000
Practice Address - Fax:818-587-2493
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71963207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A719630OtherBLUE SHIELD
CA00A719630Medicaid
CAP00088517OtherRAILROAD MEDICARE
CAP00088517OtherRAILROAD MEDICARE
CA00A719630Medicaid