Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101230921 | VA |
Y | 208000000X | Pediatrician | MD-20471 | HI |
NPI | 1013075852 |
---|---|
Provider Name | Marivic Cristobal Raymundo |
First Address | Chesapeake, VA 23320-3593 |
Second Address | Honolulu, HI 96817-4544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 10/06/2021 |