Healthcare Provider Details

I. General information

NPI: 1487419552
Provider Name (Legal Business Name): ANDREW RICHARD RONEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 01/04/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 TIVERTON DRIVE
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

885 TIVERTON DRIVE
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-6373
  • Fax:
Mailing address:
  • Phone: 310-825-6373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPTL16360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: