Provider Demographics
NPI:1811179245
Name:RAYMOND J DORIO, M.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:RAYMOND J DORIO, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DORIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-288-0081
Mailing Address - Street 1:27225 CAMP PLENTY RD
Mailing Address - Street 2:6
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-2654
Mailing Address - Country:US
Mailing Address - Phone:661-288-0081
Mailing Address - Fax:661-255-8377
Practice Address - Street 1:27225 CAMP PLENTY RD
Practice Address - Street 2:6
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-2654
Practice Address - Country:US
Practice Address - Phone:661-288-0081
Practice Address - Fax:661-255-8377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29371207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG01146Medicare UPIN