Provider Demographics
NPI:1902806136
Name:MAEDA, RALPH H JR (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:H
Last Name:MAEDA
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:26732 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 351
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6306
Mailing Address - Country:US
Mailing Address - Phone:949-364-1007
Mailing Address - Fax:949-364-6057
Practice Address - Street 1:26732 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 351
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6306
Practice Address - Country:US
Practice Address - Phone:949-364-1007
Practice Address - Fax:949-364-6057
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2010-05-21
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Provider Licenses
StateLicense IDTaxonomies
CAG43462208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG43462AOtherPIN
CAA49359Medicare UPIN