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General NPI Number Information
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NPI Number | 1912323536
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Entity Type | Individual
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Provider Name | MR. RONALD LYNN PICKERN JR.
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Gender | Male
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Dates
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Enumeration Date | 03/06/2014
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Last Update Date | 03/06/2014
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Provider Practice Location Address
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Address Line | 19506 INDUSTRIAL DR # C-2
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City | SONORA
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State | CA
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Zip | 95370-9213
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Country | US
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Telephone | 209-984-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 16457 DRAPER MINE RD
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City | SONORA
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State | CA
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Zip | 95370-8411
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Country | US
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Telephone | 209-743-2707
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Fax |
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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 | 344600000X
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Taxonomy Name | Taxi
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License Number | B4156630
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License Number State | CA
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