Provider Demographics
NPI:1558478685
Name:MITTAL, RAMESH R (MD)
Entity Type:Individual
Prefix:
First Name:RAMESH
Middle Name:R
Last Name:MITTAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5157
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92412-5157
Mailing Address - Country:US
Mailing Address - Phone:909-580-6240
Mailing Address - Fax:909-580-6308
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:ARROWHEAD REGIONAL MEDICAL CENTER
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1819
Practice Address - Country:US
Practice Address - Phone:909-580-6240
Practice Address - Fax:909-580-6308
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC43275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA006432750Medicaid
00C432750Medicare ID - Type Unspecified
CA006432750Medicaid