Provider Demographics
NPI:1447414495
Name:ALFANDARI, RONNY (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONNY
Middle Name:
Last Name:ALFANDARI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:1208
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-247-9255
Mailing Address - Fax:310-247-9240
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:1208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-247-9255
Practice Address - Fax:310-247-9240
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4842213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery