Provider Demographics
NPI:1952706418
Name:DEGUILIO, RAYMOND (LMT)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:DEGUILIO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 SE 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3656
Mailing Address - Country:US
Mailing Address - Phone:503-737-5220
Mailing Address - Fax:
Practice Address - Street 1:5336 SE BUSH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-5394
Practice Address - Country:US
Practice Address - Phone:503-737-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13047174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist