MEDICARE: MR. RONALD JOSEPH STARK RAS #S0906221308

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	RAS #S0906221308	CA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	RAS #S0906221308	CA

General Provider Information

NPI Number	:	1891826434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD JOSEPH STARK RAS #S0906221308

Provider Business Mailing Address
First Line	:	4283 EL CAJON BLVD STE 115
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1289
Country	:	US
Telephone Number	:	619-521-1743
Fax Number	:	619-521-1896

Provider Business Practice Location Address
First Line	:	4283 EL CAJON BLVD STE 115
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1289
Country	:	US
Telephone Number	:	619-521-1743
Fax Number	:	619-521-1896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	12/02/2013

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