Provider Demographics
NPI:1437534252
Name:ISRAEL, RONALD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:ISRAEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27122 PASEO ESPADA # A
Mailing Address - Street 2:SUITE 924
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-5706
Mailing Address - Country:US
Mailing Address - Phone:949-350-0557
Mailing Address - Fax:949-713-4990
Practice Address - Street 1:27122 PASEO ESPADA # A
Practice Address - Street 2:SUITE 924
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-5706
Practice Address - Country:US
Practice Address - Phone:949-350-0557
Practice Address - Fax:949-713-4990
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCI03600315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)