Healthcare Provider Details

I. General information

NPI: 1417770561
Provider Name (Legal Business Name): RONEL CUARESMA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST
SANTA ANA CA
92701-4599
US

IV. Provider business mailing address

31574 VINTNERS POINTE CT
WINCHESTER CA
92596-8318
US

V. Phone/Fax

Practice location:
  • Phone: 855-886-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number750825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: