Healthcare Provider Details

I. General information

NPI: 1992203434
Provider Name (Legal Business Name): RONALD PATRICK DETOMASO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 WINONA ST E
SAINT PAUL MN
55107-2470
US

IV. Provider business mailing address

1335 THOMPSON AVE
SOUTH SAINT PAUL MN
55075-1410
US

V. Phone/Fax

Practice location:
  • Phone: 652-955-7020
  • Fax:
Mailing address:
  • Phone: 651-789-3100
  • Fax: 651-789-0805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: