Provider Demographics
NPI:1023214954
Name:STRAHAN, RONALD W (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:W
Last Name:STRAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 N TIGERTAIL RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-2803
Mailing Address - Country:US
Mailing Address - Phone:310-925-6425
Mailing Address - Fax:310-472-3965
Practice Address - Street 1:1260 15TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1135
Practice Address - Country:US
Practice Address - Phone:310-394-0500
Practice Address - Fax:310-471-5788
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28592174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist