Provider Demographics
NPI:1770652190
Name:KURYLOWICZ, RONALD A (DO)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:KURYLOWICZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5543
Mailing Address - Country:US
Mailing Address - Phone:310-822-2999
Mailing Address - Fax:310-821-6608
Practice Address - Street 1:754 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5543
Practice Address - Country:US
Practice Address - Phone:310-822-2999
Practice Address - Fax:310-821-6608
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A4555Medicare ID - Type Unspecified
CAE05416Medicare UPIN