Individual
DR. DIANE GROTH MIMRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6001 NORRIS CANYON RD, SAN RAMON REGIONAL MEDICAL CENTER, SAN RAMON, CA 94583-5400
(925) 275-8282
Mailing address
4009 TULIP WAY, SAN RAMON, CA 94582
(925) 964-1416
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A91557
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A91557
MEDICAL LICENSE
CA
Enumeration date
06/21/2006
Last updated
07/08/2007
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