=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962723692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RALPH S DIMINYATZ MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2010
-----------------------------------------------------
Last Update Date | 06/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12401 WASHINGTON BLVD
-----------------------------------------------------
City | WHITTIER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90602-1006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-698-0811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 N TUSTIN AVE
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92705-3807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-347-1010
-----------------------------------------------------
Fax | 714-647-1245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RALPH S DIMINYATZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 714-347-1010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | G8069
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------