Provider Demographics
NPI:1164507372
Name:MAGNUSSON, RONALD LEE (AUD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEE
Last Name:MAGNUSSON
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 LOMA VISTA RD.
Mailing Address - Street 2:STE. 5A
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-620-0049
Mailing Address - Fax:805-620-0368
Practice Address - Street 1:3418 LOMA VISTA RD.
Practice Address - Street 2:STE. 5A
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-620-0049
Practice Address - Fax:805-620-0368
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU665231H00000X
CAHA973231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAUD665Medicare ID - Type Unspecified