Provider Demographics
NPI:1265433288
Name:DIRAIMONDO, CAROL ROGERS (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ROGERS
Last Name:DIRAIMONDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 LA CASA VIA
Mailing Address - Street 2:STE 210
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3091
Mailing Address - Country:US
Mailing Address - Phone:925-944-0351
Mailing Address - Fax:925-944-1957
Practice Address - Street 1:112 LA CASA VIA
Practice Address - Street 2:STE 210
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3091
Practice Address - Country:US
Practice Address - Phone:925-944-0351
Practice Address - Fax:925-944-1957
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49855207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP2044OtherRAILROAD MEDICARE
CAGR0020610Medicaid
CAGR0020610Medicaid
CP2044OtherRAILROAD MEDICARE
00G498550Medicare ID - Type Unspecified