Provider Demographics
NPI:1154467074
Name:CASTONGUAY, RONALD R (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:R
Last Name:CASTONGUAY
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 1:7255 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3831
Mailing Address - Country:US
Mailing Address - Phone:559-431-5353
Mailing Address - Fax:
Practice Address - Street 1:7255 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3831
Practice Address - Country:US
Practice Address - Phone:559-431-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17834ZOtherBLUE SHIELD
CA00A551670Medicaid
CA184324800OtherUSDL
CA00A551670Medicare PIN
CA184324800OtherUSDL