Healthcare Provider Details

I. General information

NPI: 1942284781
Provider Name (Legal Business Name): DIPAK J RANPARIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 N PRAIRIE AVE SUITE 114
INGLEWOOD CA
90301-4502
US

IV. Provider business mailing address

323 N PRAIRIE AVE SUITE 114
INGLEWOOD CA
90301-4502
US

V. Phone/Fax

Practice location:
  • Phone: 310-674-9300
  • Fax: 310-674-9301
Mailing address:
  • Phone: 310-674-9300
  • Fax: 310-674-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35408
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberC54903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: