Provider Demographics
NPI:1932406824
Name:RAYMES, PATRICIA SUE (RAYMES PATRICIA)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:SUE
Last Name:RAYMES
Suffix:
Gender:F
Credentials:RAYMES PATRICIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2175
Mailing Address - Street 2:P.O. BOX 2175
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-2175
Mailing Address - Country:US
Mailing Address - Phone:530-626-9345
Mailing Address - Fax:
Practice Address - Street 1:5465 MERCHANT CIR STE 3
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8295
Practice Address - Country:US
Practice Address - Phone:530-626-9345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA395611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice