Provider Demographics
NPI:1568015436
Name:KUSEK, RON (NSCA-CPT, CTNC, FAS)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:KUSEK
Suffix:
Gender:M
Credentials:NSCA-CPT, CTNC, FAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27340 ROCK ROSE LN APT 101
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-5155
Mailing Address - Country:US
Mailing Address - Phone:661-524-6160
Mailing Address - Fax:661-418-5916
Practice Address - Street 1:27340 ROCK ROSE LN APT 101
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-5155
Practice Address - Country:US
Practice Address - Phone:661-524-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2024-01-10
Deactivation Date:2022-01-21
Deactivation Code:
Reactivation Date:2022-10-20
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 171400000X
CA89258225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach