Provider Demographics
NPI:1073614913
Name:PERSAUD, RONALD G (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:PERSAUD
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 1:4505 LAS VIRGENES RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1956
Mailing Address - Country:US
Mailing Address - Phone:818-871-9500
Mailing Address - Fax:818-871-9550
Practice Address - Street 1:4505 LAS VIRGENES RD STE 204
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1956
Practice Address - Country:US
Practice Address - Phone:818-871-9500
Practice Address - Fax:818-871-9550
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC522762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND287171Medicare ID - Type Unspecified