Provider Demographics
NPI:1831124080
Name:MA, RONA (OMD)
Entity Type:Individual
Prefix:DR
First Name:RONA
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:RONA
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1574 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5100
Mailing Address - Country:US
Mailing Address - Phone:510-656-1047
Mailing Address - Fax:510-656-1896
Practice Address - Street 1:1574 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-5100
Practice Address - Country:US
Practice Address - Phone:510-656-1047
Practice Address - Fax:510-656-1896
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2632171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0026320Medicaid