Healthcare Provider Details

I. General information

NPI: 1518947464
Provider Name (Legal Business Name): MITCHELL C. RONNING R.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 CABRILLO COLLEGE DR
APTOS CA
95003-3166
US

IV. Provider business mailing address

2505 CABRILLO COLLEGE DR
APTOS CA
95003-3166
US

V. Phone/Fax

Practice location:
  • Phone: 831-464-3901
  • Fax: 831-464-3010
Mailing address:
  • Phone: 831-464-3901
  • Fax: 831-464-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number14184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: