Healthcare Provider Details

I. General information

NPI: 1184659617
Provider Name (Legal Business Name): RONALD S FISHBACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 WILSHIRE BLVD SUITE 203
BEVERLY HILLS CA
90211-1838
US

IV. Provider business mailing address

9001 WILSHIRE BLVD SUITE 203
BEVERLY HILLS CA
90211-1838
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-6671
  • Fax: 310-659-6237
Mailing address:
  • Phone: 310-274-6671
  • Fax: 310-659-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA39863
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: