Healthcare Provider Details

I. General information

NPI: 1881714004
Provider Name (Legal Business Name): RONALD JOHN LINDSTROM H. A. DISPENSER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 ELM AVE SUITE A
AUBURN CA
95603-4546
US

IV. Provider business mailing address

340 ELM AVE SUITE A
AUBURN CA
95603-4546
US

V. Phone/Fax

Practice location:
  • Phone: 530-888-7215
  • Fax: 530-888-6148
Mailing address:
  • Phone: 530-888-7215
  • Fax: 530-888-6148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA2423
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: