Provider Demographics
NPI:1891977732
Name:ERWIN DEIPARINE, MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ERWIN DEIPARINE, MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEIPARINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-242-8645
Mailing Address - Street 1:700 CASS ST
Mailing Address - Street 2:114
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 CASS ST
Practice Address - Street 2:114
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2916
Practice Address - Country:US
Practice Address - Phone:831-242-8645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71796208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty