Provider Demographics
NPI:1235188145
Name:ESCUDERO, RONNIE JAY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:JAY
Last Name:ESCUDERO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:RON
Other - Middle Name:
Other - Last Name:ESCUDERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:4647 ZION AVE
Mailing Address - Street 2:KAISER PERMANENTE; DEPARTMENT OF ORTHOPEDIC SURGERY
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2507
Mailing Address - Country:US
Mailing Address - Phone:866-459-2912
Mailing Address - Fax:
Practice Address - Street 1:4647 ZION AVE
Practice Address - Street 2:KAISER PERMANENTE; DEPARTMENT OF ORTHOPEDIC SURGERY
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2507
Practice Address - Country:US
Practice Address - Phone:866-459-2912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17099363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ35204Medicare UPIN