Provider Demographics
NPI:1477626497
Name:REULAND, RALF V (MD)
Entity Type:Individual
Prefix:
First Name:RALF
Middle Name:V
Last Name:REULAND
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 1:30250 RANCHO VIEJO RD STE E
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1555
Mailing Address - Country:US
Mailing Address - Phone:949-276-7400
Mailing Address - Fax:949-218-1471
Practice Address - Street 1:30250 RANCHO VIEJO RD STE E
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1555
Practice Address - Country:US
Practice Address - Phone:949-276-7400
Practice Address - Fax:949-218-1471
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F22385Medicare UPIN
CAG72259Medicare PIN