Healthcare Provider Details

I. General information

NPI: 1972124865
Provider Name (Legal Business Name): RONALD SIREGAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 E CARSON ST STE 101
CARSON CA
90745-2262
US

IV. Provider business mailing address

824 E CARSON ST STE 101
CARSON CA
90745-2262
US

V. Phone/Fax

Practice location:
  • Phone: 310-233-3203
  • Fax: 310-549-7010
Mailing address:
  • Phone: 310-233-3203
  • Fax: 310-549-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA190650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: