Healthcare Provider Details

I. General information

NPI: 1053339648
Provider Name (Legal Business Name): RONALD A DESANDRE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 EUGENIA PL SUITE A
CARPINTERIA CA
93013-2012
US

IV. Provider business mailing address

1101 EUGENIA PL SUITE A
CARPINTERIA CA
93013-2012
US

V. Phone/Fax

Practice location:
  • Phone: 805-684-0404
  • Fax: 805-684-5261
Mailing address:
  • Phone: 805-684-0404
  • Fax: 805-684-5261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC14355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: