Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A146261 | CA |
NPI | 1003294455 |
---|---|
Provider Name | Stephanie-Grace Abinoja Raymundo |
First Address | Novi, MI 48374-3763 |
Second Address | Orange, CA 92868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2015 |
Last Update Date | 05/07/2018 |