Provider Demographics
NPI:1477640001
Name:GHAZAL, RONNY G (MD)
Entity Type:Individual
Prefix:
First Name:RONNY
Middle Name:G
Last Name:GHAZAL
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1901 W LUGONIA AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-9703
Mailing Address - Country:US
Mailing Address - Phone:909-557-1600
Mailing Address - Fax:909-557-1740
Practice Address - Street 1:4234 RIVERWALK PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-8510
Practice Address - Country:US
Practice Address - Phone:909-557-1600
Practice Address - Fax:909-557-1740
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-06-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG63535207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF65204Medicare UPIN
CA00G635350Medicare ID - Type Unspecified