=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750572178
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARLES V. DIRAIMONDO, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2007
-----------------------------------------------------
Last Update Date | 05/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2485 HIGH SCHOOL AVE SUITE 112
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94520-1819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-798-2650
-----------------------------------------------------
Fax | 925-671-9173
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2485 HIGH SCHOOL AVE SUITE 112
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94520-1819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-798-2650
-----------------------------------------------------
Fax | 925-671-9173
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHARLES V DIRAIMONDO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 925-798-2650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | G60786
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------