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NPI Code Detail

MEDICARE: DR. RONALD C. KIMMONS PSYD, MSW, MA

MEDICARE: DR. RONALD C. KIMMONS PSYD, MSW, MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist

General Provider Information

NPI Number : 1003018391
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RONALD C. KIMMONS PSYD, MSW, MA
Provider Business Mailing Address
First Line : 2303 25TH AVE
Second Line :
City : OAKLAND
State : CA
Zip : 94601-1211
Country : US
Telephone Number : 510-219-6405
Fax Number :
Provider Business Practice Location Address
First Line : 2303 25TH AVE
Second Line :
City : OAKLAND
State : CA
Zip : 94601-1211
Country : US
Telephone Number : 510-219-6405
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2007
Last Update Date : 12/06/2010

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