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General NPI Number Information
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NPI Number | 1871587469
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Entity Type | Organization
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Legal Business Name | RALPH T. MITARAI, M.D., PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 01/12/2009
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Provider Practice Location Address
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Address Line | 347 ANDRIEUX ST
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City | SONOMA
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State | CA
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Zip | 95476-6811
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Country | US
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Telephone | 707-938-1480
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Fax | 707-938-1758
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Provider Business Mailing Address
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Address Line | PO BOX 2311
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City | CHATSWORTH
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State | CA
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Zip | 91313-2311
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Country | US
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Telephone | 818-718-9500
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Fax | 818-718-9507
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Authorized Official
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Title or Position | PRESIDENT
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Name | RALPH T MITARAI
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Credential | M.D.
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Telephone | 707-938-1480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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