Provider Demographics
NPI:1558807685
Name:FARRIS, RONALD I (RADT 1)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:FARRIS
Suffix:I
Gender:M
Credentials:RADT 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 W 112TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-4928
Mailing Address - Country:US
Mailing Address - Phone:323-836-2001
Mailing Address - Fax:213-388-1317
Practice Address - Street 1:155 BIMINI PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5902
Practice Address - Country:US
Practice Address - Phone:213-388-5423
Practice Address - Fax:213-388-1317
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)