Provider Demographics
NPI:1720065626
Name:COFFIN, RAYMOND JOHN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JOHN
Last Name:COFFIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3094 BUCKHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-4362
Mailing Address - Country:US
Mailing Address - Phone:951-741-2249
Mailing Address - Fax:909-548-7405
Practice Address - Street 1:106 E BADILLO ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2113
Practice Address - Country:US
Practice Address - Phone:626-915-7581
Practice Address - Fax:626-915-7588
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15496103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY15496OtherPSYCHOLOGIST LICENSE
CACP15496Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER