Provider Demographics
NPI:1578536587
Name:JENKINS, RONALD WILLIAM (BCHIS-ACA)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:WILLIAM
Last Name:JENKINS
Suffix:
Gender:M
Credentials:BCHIS-ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4627
Mailing Address - Country:US
Mailing Address - Phone:707-554-6660
Mailing Address - Fax:707-558-1062
Practice Address - Street 1:1534 TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4627
Practice Address - Country:US
Practice Address - Phone:707-554-6660
Practice Address - Fax:707-558-1062
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA18390237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0018390Medicaid