Provider Demographics
NPI:1104834183
Name:MARMOLEJO, RONALD P (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:P
Last Name:MARMOLEJO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515W MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3303
Mailing Address - Country:US
Mailing Address - Phone:559-781-0364
Mailing Address - Fax:559-781-3625
Practice Address - Street 1:515 W MORTON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257
Practice Address - Country:US
Practice Address - Phone:559-781-0364
Practice Address - Fax:559-781-3625
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2925213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E29250Medicaid
T11517Medicare UPIN
CA000E29250Medicaid