Provider Demographics
NPI:1043828262
Name:SIMPSON, RONALD RAMON (PA-C)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:RAMON
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 BUTTON AVE APT 169
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-9595
Mailing Address - Country:US
Mailing Address - Phone:678-770-0208
Mailing Address - Fax:
Practice Address - Street 1:1050 IRON POINT RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8013
Practice Address - Country:US
Practice Address - Phone:916-597-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58718363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant