Provider Demographics
NPI:1063489128
Name:PEPITONE, RONALD E JR (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:E
Last Name:PEPITONE
Suffix:JR
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 1:4281 KATELLA AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3500
Mailing Address - Country:US
Mailing Address - Phone:562-988-7000
Mailing Address - Fax:714-226-0681
Practice Address - Street 1:4281 KATELLA AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3500
Practice Address - Country:US
Practice Address - Phone:562-988-7000
Practice Address - Fax:714-226-0681
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53067207R00000X
HIMD12985207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF16072Medicare UPIN