Provider Demographics
NPI:1841382876
Name:RONLOV, CARSTEN S (MD)
Entity Type:Individual
Prefix:DR
First Name:CARSTEN
Middle Name:S
Last Name:RONLOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 KATELLA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3309
Mailing Address - Country:US
Mailing Address - Phone:562-429-9433
Mailing Address - Fax:562-429-9544
Practice Address - Street 1:3851 KATELLA AVE STE 300
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3566
Practice Address - Country:US
Practice Address - Phone:562-429-9433
Practice Address - Fax:562-429-9544
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35029207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84721Medicare UPIN
CAWA35029AMedicare PIN