Healthcare Provider Details

I. General information

NPI: 1700896776
Provider Name (Legal Business Name): RONALD WILLIAM WOERPEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2176 SALK AVE
CARLSBAD CA
92008-7346
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD MAIL DROP 4S-205
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 760-827-7430
  • Fax: 760-827-7425
Mailing address:
  • Phone: 760-827-7430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG38665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: