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General NPI Number Information
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NPI Number | 1104897289
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Entity Type | Individual
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Provider Name | RONALD ERIC GLOUSMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 999 N TUSTIN AVE SUITE 114
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City | SANTA ANA
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State | CA
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Zip | 92705-3528
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Country | US
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Telephone | 310-659-9116
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Fax | 866-807-7466
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Provider Business Mailing Address
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Address Line | PO BOX 570627
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City | TARZANA
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State | CA
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Zip | 91357-0627
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Country | US
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Telephone | 310-659-9116
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Fax | 866-807-7466
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | G45186
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G45186
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License Number State | CA
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