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NPI Code Detail

MEDICARE: DR. RON SKLASH M.D.

MEDICARE: DR. RON SKLASH M.D.
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207RC0000XCardiovascular Disease PhysicianA123693CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ZZZ73964ZOTHERCAMEDI-CAL

General Provider Information

NPI Number : 1598914574
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RON SKLASH M.D.
Provider Business Mailing Address
First Line : 1400 MAGNOLIA AVE
Second Line :
City : MANHATTAN BEACH
State : CA
Zip : 90266-5219
Country : US
Telephone Number : 954-682-1858
Fax Number :
Provider Business Practice Location Address
First Line : 2898 LINDEN AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-1627
Country : US
Telephone Number : 562-595-8671
Fax Number : 562-490-2015
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2008
Last Update Date : 11/05/2015

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