Provider Demographics
NPI:1093732992
Name:DAOUD, RONALD (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:DAOUD
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 1:1010 W LA VETA AVE
Mailing Address - Street 2:STE 610
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4304
Mailing Address - Country:US
Mailing Address - Phone:707-339-8802
Mailing Address - Fax:714-285-2319
Practice Address - Street 1:1010 W LA VETA AVE
Practice Address - Street 2:STE 610
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4304
Practice Address - Country:US
Practice Address - Phone:707-339-8802
Practice Address - Fax:714-285-2319
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51211207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA75-2987865OtherINDIVIDUAL TAX ID
CA00A512110Medicaid
CABD2877263OtherDEA
CAF41070Medicare UPIN
CAA51211Medicare PIN