Provider Demographics
NPI:1649301946
Name:RAZON, ANNABELLE S
Entity type:Individual
Prefix:DR
First Name:ANNABELLE
Middle Name:S
Last Name:RAZON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ANNABELLE
Other - Middle Name:S
Other - Last Name:RAZON SAN AUGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9190 MIRA MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4804
Mailing Address - Country:US
Mailing Address - Phone:858-689-1814
Mailing Address - Fax:858-689-1807
Practice Address - Street 1:9190 MIRA MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4804
Practice Address - Country:US
Practice Address - Phone:858-689-1814
Practice Address - Fax:858-689-1807
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7736423Medicaid
CACH5540Medicare ID - Type Unspecified
CA7736423Medicaid