Provider Demographics
NPI:1285458026
Name:CODY, RAYMOND TERRELL
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:TERRELL
Last Name:CODY
Suffix:
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 1:43259 CARPENTER DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-2964
Mailing Address - Country:US
Mailing Address - Phone:661-944-7566
Mailing Address - Fax:
Practice Address - Street 1:44349 LOWTREE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4100
Practice Address - Country:US
Practice Address - Phone:661-228-0567
Practice Address - Fax:205-509-5377
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator