Provider Demographics
NPI:1033438478
Name:MYERS, RONALD DENNIS
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DENNIS
Last Name:MYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 EMELINE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1976
Mailing Address - Country:US
Mailing Address - Phone:831-454-4971
Mailing Address - Fax:831-454-4663
Practice Address - Street 1:1051 CAYUGA ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2421
Practice Address - Country:US
Practice Address - Phone:831-469-0462
Practice Address - Fax:831-469-9160
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC 70044FOtherSANTA CRUZ COUNTY MEDI-CAL GROUP PROVIDER#
CAZZZ91891ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CAZZZ91892ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CAFHC 70042FOtherSANTA CRUZ COUNTY MEDI-CAL GROUP PROVIDER
CAZZZ92069ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN#