Healthcare Provider Details

I. General information

NPI: 1720192685
Provider Name (Legal Business Name): RONALD V BJARNASON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8397 N LANDER AVE
HILMAR CA
95324-0179
US

IV. Provider business mailing address

PO BOX 1179
HILMAR CA
95324-0179
US

V. Phone/Fax

Practice location:
  • Phone: 209-669-2655
  • Fax: 209-669-2657
Mailing address:
  • Phone: 209-669-2655
  • Fax: 209-669-2657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A5161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: