Provider Demographics
NPI:1558432989
Name:TASSINARI, RALPH JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:JOSEPH
Last Name:TASSINARI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27871 MEDICAL CENTER ROAD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-364-0944
Mailing Address - Fax:949-364-1365
Practice Address - Street 1:27871 MEDICAL CENTER ROAD
Practice Address - Street 2:SUITE 170
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-364-0944
Practice Address - Fax:949-364-1365
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5461103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP5461Medicare ID - Type Unspecified