Provider Demographics
NPI:1932510807
Name:RAYMOND BADILLO, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RAYMOND BADILLO, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:BADILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-508-6785
Mailing Address - Street 1:6 MALAGA PL. E.
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266
Mailing Address - Country:US
Mailing Address - Phone:310-546-5797
Mailing Address - Fax:310-546-5797
Practice Address - Street 1:436 N BEDFORD DRIVE
Practice Address - Street 2:#305
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-508-6785
Practice Address - Fax:310-546-5797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52698207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA5Z324Medicare UPIN