Provider Demographics
NPI:1821043498
Name:MIMRAN, RONNIE ISAAC (MD)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:ISAAC
Last Name:MIMRAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1320 EL CAPITAN DR
Mailing Address - Street 2:#300
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-6258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20055 LAKE CHABOT RD
Practice Address - Street 2:#110
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546
Practice Address - Country:US
Practice Address - Phone:510-886-3138
Practice Address - Fax:510-373-1616
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA90574207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I31556Medicare UPIN
CA00A905740Medicare ID - Type Unspecified