Healthcare Provider Details

I. General information

NPI: 1306605639
Provider Name (Legal Business Name): RONALD AARON DEOPANTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W CIVIC CENTER DR STE 200
SANTA ANA CA
92701-4052
US

IV. Provider business mailing address

1910 N BUSH ST
SANTA ANA CA
92706-2816
US

V. Phone/Fax

Practice location:
  • Phone: 714-795-3444
  • Fax: 714-795-3445
Mailing address:
  • Phone: 714-795-3444
  • Fax: 714-795-3445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: