Healthcare Provider Details

I. General information

NPI: 1174506661
Provider Name (Legal Business Name): RALPH G DREIER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 LAURSEN ST
HEMET CA
92543-4437
US

IV. Provider business mailing address

241 LAURSEN ST
HEMET CA
92543-4437
US

V. Phone/Fax

Practice location:
  • Phone: 951-658-3258
  • Fax: 951-658-1299
Mailing address:
  • Phone: 951-658-3258
  • Fax: 951-658-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number00A288820
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number00A288820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: