Healthcare Provider Details

I. General information

NPI: 1003850082
Provider Name (Legal Business Name): RONALD OLSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13855 E 14TH ST
SAN LEANDRO CA
94578-2611
US

IV. Provider business mailing address

175 LENNON LN SUITE 100
WALNUT CREEK CA
94598-2485
US

V. Phone/Fax

Practice location:
  • Phone: 925-296-7156
  • Fax: 925-296-7174
Mailing address:
  • Phone: 925-296-7156
  • Fax: 925-296-7174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG25998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: