Provider Demographics
NPI:1942412291
Name:BIRNBAUM, RON ALEXANDER (MD,)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:ALEXANDER
Last Name:BIRNBAUM
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 1:863 LUCILE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-1509
Mailing Address - Country:US
Mailing Address - Phone:310-570-7829
Mailing Address - Fax:
Practice Address - Street 1:1024 W. CARSON
Practice Address - Street 2:LOS ANGELES COUNTY HARBOR UCLA MEDICAL CENTER
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90509
Practice Address - Country:US
Practice Address - Phone:310-781-1396
Practice Address - Fax:310-781-9328
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83358208D00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice