Provider Demographics
NPI:1255400248
Name:PEREZ-PASILIAO, RAIMEL YTURRALDE (MD)
Entity type:Individual
Prefix:DR
First Name:RAIMEL
Middle Name:YTURRALDE
Last Name:PEREZ-PASILIAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RAIMEL PELAGIA
Other - Middle Name:YTURRALDE
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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:562-365-3532
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:909-627-7433
Practice Address - Fax:562-365-3532
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86687208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1750506689OtherCOMMERCIAL INSURANCE
CA1750506689OtherHMO INSURANCE