Provider Demographics
NPI:1750506689
Name:RAIMEL Y. PEREZ-PASILIAO, MD, INC.
Entity Type:Organization
Organization Name:RAIMEL Y. PEREZ-PASILIAO, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAIMEL
Authorized Official - Middle Name:YTURRALDE
Authorized Official - Last Name:PEREZ-PASILIAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-674-5284
Mailing Address - Street 1:7940 SERENITY FALLS RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3396
Mailing Address - Country:US
Mailing Address - Phone:626-674-5284
Mailing Address - Fax:909-627-7433
Practice Address - Street 1:12574 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3507
Practice Address - Country:US
Practice Address - Phone:626-674-5284
Practice Address - Fax:909-627-7433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA866872080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI05076Medicare UPIN