Provider Demographics
NPI:1104882539
Name:DELORENZI, RAYMOND J (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:J
Last Name:DELORENZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 MERCY AVE STE 400
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8368
Practice Address - Country:US
Practice Address - Phone:209-564-3700
Practice Address - Fax:209-564-3799
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC183342207X00000X
FLME42589207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4075860OtherAETNA
FL02703OtherFLORIDA BLUE
FL8018298OtherCIGNA
FL4075860OtherAETNA
FL6655870001Medicare NSC
FL02703TMedicare PIN