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General NPI Number Information
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NPI Number | 1972300762
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Entity Type | Individual
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Provider Name | RONALD DERAYUNAN NP
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Gender | Male
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Dates
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Enumeration Date | 02/27/2025
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 1720 E LOS ANGELES AVE STE 231
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City | SIMI VALLEY
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State | CA
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Zip | 93065-5813
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Country | US
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Telephone | 310-980-7475
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Fax |
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Provider Business Mailing Address
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Address Line | 2788 FYLER PL
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City | LOS ANGELES
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State | CA
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Zip | 90065-5106
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Country | US
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Telephone | 213-500-4952
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95034129
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License Number State | CA
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