Provider Demographics
NPI:1619623097
Name:MCDONALD, RAYMOND MEHRDAD
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:MEHRDAD
Last Name:MCDONALD
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:VA LOMA LINDA HEALTHCARE SYSTEM
Mailing Address - Street 2:11201 BENTON ST, SERVICE MAILCODE: 008
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92357
Mailing Address - Country:US
Mailing Address - Phone:909-825-7084
Mailing Address - Fax:909-777-3857
Practice Address - Street 1:VA LOMA LINDA HEALTHCARE SYSTEM
Practice Address - Street 2:11201 BENTON ST, SERVICE MAILCODE: 008
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:909-777-3857
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral