Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 106476 | CA |
Y | 213EG0000X | General Practice | 106476 | CA |
NPI | 1003487414 |
---|---|
Provider Name | Patricia Raygada-Rabanal |
First Address | Chula Vista, CA 91914-4616 |
Second Address | Lemon Grove, CA 91945-2967 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2021 |
Last Update Date | 07/07/2021 |