Provider Demographics
NPI:1659085447
Name:CABAGNOT, RON RYAN D (BSN)
Entity Type:Individual
Prefix:
First Name:RON RYAN
Middle Name:D
Last Name:CABAGNOT
Suffix:
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13434 BARLIN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-5106
Mailing Address - Country:US
Mailing Address - Phone:562-417-4807
Mailing Address - Fax:
Practice Address - Street 1:13434 BARLIN AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-5106
Practice Address - Country:US
Practice Address - Phone:562-417-4807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95102355163WH0500X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis