Provider Demographics
NPI:1265465579
Name:KORETZ, RONALD LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEE
Last Name:KORETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:16847 COLVEN RD
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-1855
Mailing Address - Country:US
Mailing Address - Phone:818-360-2708
Mailing Address - Fax:818-364-4573
Practice Address - Street 1:14445 OLIVE VIEW DR
Practice Address - Street 2:DEPT MEDICINE OLIVE VIEW UCLA MEDICAL CENTER
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342
Practice Address - Country:US
Practice Address - Phone:818-364-3205
Practice Address - Fax:818-364-4573
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA023109207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A23398Medicare UPIN