Provider Demographics
NPI:1750475133
Name:COSCUNA, RONALD ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ANTHONY
Last Name:COSCUNA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4349 FOREST RANCH RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6526
Mailing Address - Country:US
Mailing Address - Phone:760-717-4165
Mailing Address - Fax:760-722-0642
Practice Address - Street 1:1012 S COAST HWY STE G
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-5072
Practice Address - Country:US
Practice Address - Phone:760-722-1381
Practice Address - Fax:760-722-0642
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24903111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24903Medicare ID - Type Unspecified
CAU68274Medicare UPIN