Healthcare Provider Details

I. General information

NPI: 1932657137
Provider Name (Legal Business Name): MR. RONNIE MCDOWELL SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 NEWBERRY DR
SAN JOSE CA
95118-1564
US

IV. Provider business mailing address

3180 NEWBERRY DR
SAN JOSE CA
95118-1564
US

V. Phone/Fax

Practice location:
  • Phone: 408-691-0448
  • Fax: 408-266-0124
Mailing address:
  • Phone: 408-691-0448
  • Fax: 408-266-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: