Provider Demographics
NPI:1891748836
Name:ISSA, RAMON A (MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:A
Last Name:ISSA
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:FILE # 54701
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-4701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25333 BARTON RD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-0210
Practice Address - Country:US
Practice Address - Phone:909-558-6641
Practice Address - Fax:909-558-6039
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.083971-I207P00000X
OH35083971207Q00000X
CAC130915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000389552OtherANTHEM
CA1891748836OtherNPI
OH4139737Medicare PIN
OHI13266Medicare UPIN