Healthcare Provider Details

I. General information

NPI: 1407496433
Provider Name (Legal Business Name): RONAN BASILLOTE PATONONA NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 09/26/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16660 PARAMOUNT BLVD STE 306
PARAMOUNT CA
90723-5459
US

IV. Provider business mailing address

3187 E MT RAINIER DR
ONTARIO CA
91762-7272
US

V. Phone/Fax

Practice location:
  • Phone: 562-303-6862
  • Fax:
Mailing address:
  • Phone: 562-303-6862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: