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General NPI Number Information
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NPI Number | 1154690774
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Entity Type | Organization
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Legal Business Name | RONALD A KALAYTA MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/28/2011
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 901 MAPLE AVE
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City | YUBA CITY
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State | CA
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Zip | 95991-3323
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Country | US
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Telephone | 530-674-8170
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Fax | 530-674-5728
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Provider Business Mailing Address
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Address Line | 901 MAPLE AVE
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City | YUBA CITY
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State | CA
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Zip | 95991-3323
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Country | US
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Telephone | 530-674-8170
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Fax | 530-674-5728
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD A KALAYTA
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Credential | M.D.
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Telephone | 530-674-8170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G228240
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License Number State | CA
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