Provider Demographics
NPI:1700170859
Name:RAYMUNDO, DENNIS PANSACOLA (SFIDC)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:PANSACOLA
Last Name:RAYMUNDO
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35463 SUGAR MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-7942
Mailing Address - Country:US
Mailing Address - Phone:619-764-3059
Mailing Address - Fax:
Practice Address - Street 1:H100 SANTA MARGARITA RD
Practice Address - Street 2:NAVAL HOSPITAL CAMP PENDLETON
Practice Address - City:OCEAN SIDE
Practice Address - State:CA
Practice Address - Zip Code:92058
Practice Address - Country:US
Practice Address - Phone:760-763-6529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman