Provider Demographics
NPI:1598914574
Name:SKLASH, RON (MD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:
Last Name:SKLASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5219
Mailing Address - Country:US
Mailing Address - Phone:954-682-1858
Mailing Address - Fax:
Practice Address - Street 1:2898 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1627
Practice Address - Country:US
Practice Address - Phone:562-595-8671
Practice Address - Fax:562-490-2015
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA123693207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ73964ZOtherMEDI-CAL
CACB210036Medicare UPIN
CAW3230Medicare PIN
CAZZZ73964ZOtherMEDI-CAL