Healthcare Provider Details

I. General information

NPI: 1922421171
Provider Name (Legal Business Name): RONALD GLOUSMAN MD MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N TUSTIN AVE STE 114
SANTA ANA CA
92705-3528
US

IV. Provider business mailing address

PO BOX 570627
TARZANA CA
91357-0627
US

V. Phone/Fax

Practice location:
  • Phone: 714-508-1981
  • Fax: 866-807-7466
Mailing address:
  • Phone: 310-659-9116
  • Fax: 866-807-7466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD ERIC GLOUSMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 714-313-1454