Provider Demographics
NPI:1275769879
Name:KORWALD, RONALD MARK (ADDICTIONOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:MARK
Last Name:KORWALD
Suffix:
Gender:M
Credentials:ADDICTIONOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HARBOR BLVD
Mailing Address - Street 2:BUILDING C
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-4047
Mailing Address - Country:US
Mailing Address - Phone:650-802-6429
Mailing Address - Fax:650-802-6440
Practice Address - Street 1:400 HARBOR BLVD
Practice Address - Street 2:BUILDING C
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-4047
Practice Address - Country:US
Practice Address - Phone:650-802-6429
Practice Address - Fax:650-802-6440
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)