Provider Demographics
NPI:1174506661
Name:DREIER, RALPH G
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:G
Last Name:DREIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 LAURSEN ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4437
Mailing Address - Country:US
Mailing Address - Phone:951-658-3258
Mailing Address - Fax:951-658-1299
Practice Address - Street 1:241 LAURSEN ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4437
Practice Address - Country:US
Practice Address - Phone:951-658-3258
Practice Address - Fax:951-658-1299
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A288820208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3571616Medicaid
CA3571616Medicaid
CACO3869Medicare UPIN