Provider Demographics
NPI:1326628652
Name:WANGRATTANAPRANEE, PEERAPOL (MD)
Entity Type:Individual
Prefix:
First Name:PEERAPOL
Middle Name:
Last Name:WANGRATTANAPRANEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92521-9800
Mailing Address - Country:US
Mailing Address - Phone:909-475-2612
Mailing Address - Fax:909-475-5059
Practice Address - Street 1:900 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92521-1029
Practice Address - Country:US
Practice Address - Phone:909-475-2612
Practice Address - Fax:909-475-5059
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA191810207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology