Healthcare Provider Details

I. General information

NPI: 1508134271
Provider Name (Legal Business Name): RONDA LEEANNE TRAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S HORNE ST APT E
OCEANSIDE CA
92054-3044
US

IV. Provider business mailing address

115 S HORNE ST APT E
OCEANSIDE CA
92054-3044
US

V. Phone/Fax

Practice location:
  • Phone: 714-414-8347
  • Fax:
Mailing address:
  • Phone: 714-414-8347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberPT34304
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: