Provider Demographics
NPI:1922171420
Name:AMOS, RONALD D (PHD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:AMOS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41381 JAMAICA SANDS DR
Mailing Address - Street 2:
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-1471
Mailing Address - Country:US
Mailing Address - Phone:760-553-5754
Mailing Address - Fax:
Practice Address - Street 1:41381 JAMAICA SANDS DR
Practice Address - Street 2:
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-1471
Practice Address - Country:US
Practice Address - Phone:760-553-5754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10032103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP10032Medicare ID - Type UnspecifiedMEDICARE