Provider Demographics
NPI:1730117557
Name:MANNING, RAYMOND A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:A
Last Name:MANNING
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 1:8309 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-4920
Mailing Address - Country:US
Mailing Address - Phone:562-928-5545
Mailing Address - Fax:562-928-5540
Practice Address - Street 1:8309 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4920
Practice Address - Country:US
Practice Address - Phone:562-928-5545
Practice Address - Fax:562-928-5540
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG3261412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G326411Medicaid
G32641Medicare ID - Type Unspecified
CAA45225Medicare UPIN
CA00G326411Medicaid