Provider Demographics
NPI:1982759866
Name:RAYGADA, JAVIER (DDS)
Entity type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:
Last Name:RAYGADA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1837 CAMINO MOJAVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4616
Mailing Address - Country:US
Mailing Address - Phone:619-216-3092
Mailing Address - Fax:619-420-1623
Practice Address - Street 1:345 F ST STE 290
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2649
Practice Address - Country:US
Practice Address - Phone:619-420-4523
Practice Address - Fax:619-420-1623
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice