Provider Demographics
NPI:1104835404
Name:BAUMGARTNER, RONALD PAUL (PA)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:PAUL
Last Name:BAUMGARTNER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W PARKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-7222
Mailing Address - Country:US
Mailing Address - Phone:562-360-7591
Mailing Address - Fax:
Practice Address - Street 1:231 W PARKWOOD AVE
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-7222
Practice Address - Country:US
Practice Address - Phone:562-360-7591
Practice Address - Fax:213-626-2512
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 13047207Q00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13047OtherP.A. LICENSE