Healthcare Provider Details

I. General information

NPI: 1316999006
Provider Name (Legal Business Name): RONALD MARCIANO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16111 PLUMMER ST
NORTH HILLS CA
91343-2036
US

IV. Provider business mailing address

392 SPRING BREEZE CT
SIMI VALLEY CA
93065-6722
US

V. Phone/Fax

Practice location:
  • Phone: 818-891-7711
  • Fax:
Mailing address:
  • Phone: 805-527-8762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: