Provider Demographics
NPI:1124450325
Name:PIERRE, RAYGENALD JACQUES (COTA/L)
Entity type:Individual
Prefix:
First Name:RAYGENALD
Middle Name:JACQUES
Last Name:PIERRE
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11031 JERRY LN
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-3318
Mailing Address - Country:US
Mailing Address - Phone:619-840-6043
Mailing Address - Fax:
Practice Address - Street 1:11031 JERRY LN
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-3318
Practice Address - Country:US
Practice Address - Phone:619-840-6043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1438222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist