Provider Demographics
NPI:1083031835
Name:MAGSAYSAY, RAYMOND AQUINO JR
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:AQUINO
Last Name:MAGSAYSAY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7702 ALDEA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2107
Mailing Address - Country:US
Mailing Address - Phone:818-599-2737
Mailing Address - Fax:
Practice Address - Street 1:7702 ALDEA AVE
Practice Address - Street 2:
Practice Address - City:LAKE BALBOA
Practice Address - State:CA
Practice Address - Zip Code:91406-2107
Practice Address - Country:US
Practice Address - Phone:818-599-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver