Provider Demographics
NPI:1942488275
Name:RONALD H PELTZ DPM
Entity Type:Organization
Organization Name:RONALD H PELTZ DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:PELTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:323-567-1201
Mailing Address - Street 1:4225 TWEEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6217
Mailing Address - Country:US
Mailing Address - Phone:323-567-1201
Mailing Address - Fax:323-567-1211
Practice Address - Street 1:4225 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6217
Practice Address - Country:US
Practice Address - Phone:323-567-1201
Practice Address - Fax:323-567-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1451A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5508570001Medicare NSC