Provider Demographics
NPI:1760723290
Name:LORD, RON CLYDE JR (CALAC 9362)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:CLYDE
Last Name:LORD
Suffix:JR
Gender:M
Credentials:CALAC 9362
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Mailing Address - Street 1:12396 WORLD TRADE DR STE 117
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3788
Mailing Address - Country:US
Mailing Address - Phone:858-458-0625
Mailing Address - Fax:858-750-2174
Practice Address - Street 1:12396 WORLD TRADE DR STE 117
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3788
Practice Address - Country:US
Practice Address - Phone:858-458-0625
Practice Address - Fax:858-750-2174
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2023-10-03
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Provider Licenses
StateLicense IDTaxonomies
CA9362171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist