Provider Demographics
NPI:1902363112
Name:ANTHONY, RONALD WILLIAM (NP)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:WILLIAM
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:2523 N MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1545
Mailing Address - Country:US
Mailing Address - Phone:951-662-1151
Mailing Address - Fax:
Practice Address - Street 1:11234 ANDERSON STREET
Practice Address - Street 2:SP 1617 ATTN: STEVIE
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-558-4200
Practice Address - Fax:909-558-4212
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP95011004363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily