Carmelita Antoquia Raymundo-Devera, M.D.
Individual provider Active NPI Pediatrics Physician · Hesperia, CA
NPI 1417033374 · NPPES record last updated Dec 22, 2021
Key facts
- NPI
- 1417033374
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- A55746 (CA)
- Practice address
- 16455 Main St.
Suite 1
Hesperia, CA 92345 - Phone
- (760) 947-2161
- Fax
- (760) 947-3673
- NPI assigned
- Oct 31, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Pediatric Medicine
- Education
- Other, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
PO Box
Suite 2984
Ceres, CA 95307
PO Box
Suite 908
Corning, CA 96021-0908
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071105000240 | CA | Practitioner - Pediatric Medicine | 7416044672 | Reassigns benefits to 2 organizations |
| I20251222000097 | TX | Practitioner - Pediatric Medicine | 7416044672 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A55746 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Rolling Hills Clinic | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current | Accepting new patients | |
| Southern California Permanente Medical Group | Current | Accepting new patients | |
| Rolling Hills Clinic | Current |
Accepting new patients | |
| Providence Facey Medical Foundation | Past | Accepting new patients |
Locations
740 Solano St
Corning, CA 96021
Phone (530) 690-2827
9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910
4733 W Sunset Blvd
Los Angeles, CA 90027
Phone (213) 667-4784
13652 Cantara St
Panorama City, CA 91402
Phone (818) 375-2417
393 E Walnut St
Fl 5
Pasadena, CA 91188
Phone (310) 403-3235
2540 Sister Mary Columba Dr
Red Bluff, CA 96080
Phone (530) 528-8899
10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A55746 | CA | Yes |
Addresses
Primary practice location
16455 Main St.
Suite 1
Hesperia, CA 92345
Mailing address
685 Carnegie Dr.
Suite 230
San Bernardino, CA 92408-3583
Phone (909) 890-0407
Other names
- Carmelita Antoquia Raymundo
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) | Southern California Permanente Medical Group |
Other providers in Hesperia, CA
- Vanessa Ramirez
- Laura Jennifer Ramos
- Maritza Guzman Ramos
- Telesforo Mondares Ramos
- Briel La Nae Rascon
- Cynthia Louise Rea
- Kartik K Reddy
- Krystal Marie Redman
- Wyatt Reese
- Melanie Regalado
All providers in Hesperia, CA · Pediatrics Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.