Healthcare Provider Details

I. General information

NPI: 1700512340
Provider Name (Legal Business Name): RONALD E NEWMAN CATC-IV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7515 VAN NUYS BLVD
VAN NUYS CA
91405-1949
US

IV. Provider business mailing address

7515 VAN NUYS BLVD
VAN NUYS CA
91405-1949
US

V. Phone/Fax

Practice location:
  • Phone: 323-252-7521
  • Fax:
Mailing address:
  • Phone: 323-252-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number205651-IV
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: