Provider Demographics
NPI:1578507679
Name:DEL MAR, RAOUL B (MD)
Entity Type:Individual
Prefix:
First Name:RAOUL
Middle Name:B
Last Name:DEL MAR
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9380 COURTNEY WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-9147
Mailing Address - Country:US
Mailing Address - Phone:916-218-8808
Mailing Address - Fax:916-771-5453
Practice Address - Street 1:6508 LONETREE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5874
Practice Address - Country:US
Practice Address - Phone:916-771-5533
Practice Address - Fax:916-771-5453
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAA891662080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20-5992250OtherEIN