Provider Demographics
NPI:1396784401
Name:MORALES, RAYMUNDO A (MD)
Entity type:Individual
Prefix:
First Name:RAYMUNDO
Middle Name:A
Last Name:MORALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2200
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-0722
Mailing Address - Country:US
Mailing Address - Phone:909-795-9747
Mailing Address - Fax:909-797-3922
Practice Address - Street 1:33758 YUCAIPA BLVD
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2243
Practice Address - Country:US
Practice Address - Phone:909-795-9747
Practice Address - Fax:909-797-3922
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64001207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A640010Medicaid
CAH19891Medicare UPIN