Provider Demographics
NPI:1780191353
Name:STERLING, RAYNARD (NP)
Entity Type:Individual
Prefix:MR
First Name:RAYNARD
Middle Name:
Last Name:STERLING
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 VAN WICK ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-4644
Mailing Address - Country:US
Mailing Address - Phone:310-351-2643
Mailing Address - Fax:
Practice Address - Street 1:545 ROSE HILL LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-5714
Practice Address - Country:US
Practice Address - Phone:310-351-2643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA736881163WP2201X
GARN2984873363LF0000X
GARN298483363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care