Healthcare Provider Details

I. General information

NPI: 1104835404
Provider Name (Legal Business Name): RONALD PAUL BAUMGARTNER P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 W PARKWOOD AVE
LA HABRA CA
90631-7222
US

IV. Provider business mailing address

231 W PARKWOOD AVE
LA HABRA CA
90631-7222
US

V. Phone/Fax

Practice location:
  • Phone: 562-360-7591
  • Fax: 213-626-2512
Mailing address:
  • Phone: 562-360-7591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA 13047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: