Provider Demographics
NPI:1083649818
Name:GANDOLFO, RONALD LAWRENCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LAWRENCE
Last Name:GANDOLFO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 N PALM AVE
Mailing Address - Street 2:SUITE 605
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2211
Mailing Address - Country:US
Mailing Address - Phone:559-226-9488
Mailing Address - Fax:559-226-9461
Practice Address - Street 1:5151 N PALM AVE
Practice Address - Street 2:SUITE 605
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2211
Practice Address - Country:US
Practice Address - Phone:559-226-9488
Practice Address - Fax:559-226-9461
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3782103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL37820Medicare ID - Type Unspecified